Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal

Manual therapy and transcranial magnetic stimulation in the pain control in knee osteoarthritis: literature review

Mannaly Mendonça, Camilla Fonseca, Maíra Lima, Luiz Mèlo, Sérgio Rocha, Marcelo Guerino, Ana Paula Lima, Maria das Graças Araújo, Kátia Monte-Silva

Downloads: 1
Views: 482


Background: Osteoarthritis (OA) is an incurable disorder that affects all joints and adjacent tissues, whose degeneration of articular cartilage results from a combination of factors; whereas knee osteoarthritis (KOA) is a disabling factor and pain is the major cause of physical limitations, reducing the mobility of elderly subjects. Objective: To verify the incidence of articles that discourse about manual therapy (MT) performance in the peripheral and central aspect of chronic pain and transcranial magnetic stimulation (rTMS) in the central aspect of pain. Method: Literature review conducted on Medline in English language without any date limit. The used and combined terms were Osteoarthritis, knee, chronic pain, musculoskeletal manipulations and transcranial magnetic stimulation. Articles with techniques of manual therapy and repetitive transcranial magnetic stimulation in chronic pain were included in the study. Whereas articles discussing association with other therapeutic techniques were excluded from the study. Results: It was found articles that analyzed subjects with chronic pain derived from KOA, investigated the behavior of the central nervous system of the subjects with KOA and the transcranial magnetic stimulation in the motor cortex of patients with chronic pain and also the performance of MT in the peripheral and central aspects of chronic pain. Conclusion: There is a need for studies that primarily investigate the effect of these two techniques in a short term and subsequently longer protocols to minimize pain in these patients.


Osteoarthritis; Knee; Chronic Pain; Musculoskeletal Manipulations; Transcranial Magnetic Stimulation.


1. Loures FB, Araújo GRF, Labronici PJ, Barretto JM, Olej B. Avaliação do índice de massa corporal como fator prognóstico na osteoartrose do joelho. Rev Bras de Ortopedia. 2016; 51(4): 400–04.

2. Herrero-Beaumont G, Roman-Blas JA, Bruyère O, Cooper C, Kanis J, Maggi S, et al. Clinical settings in knee osteoarthritis: Pathophysiology guides treatment. Maturitas. 2017; 96: 54–57.

3. Agaliotis M, Mackey MG, Jan S, Frasen M. Burden of reduced work productivity among people with chronic knee pain: A systematic review. Occupational and Envl Medicine. 2014; 71(9): 651–59.

4. Dwyer L, Parkin-Smith GF, Brantingham JW, Korporaal C, Cassa TK, Globe G, et al. Manual and manipulative therapy in addition to rehabilitation for osteoarthritis of the knee: Assessor-blind randomized pilot trial. Journal of Manipulative and Physiological Therapeutics. 2015; 38(1): 1–21.

5. Souza IFS, Oliveira Neta RS, Gazzola JM, Souza MC. Idosos com osteoartrite do joelho devem realizar avaliação nutricional: revisão integrativa da literatura. Einstein. 2017; 15(2): 226-232.

6. Bennell KL, Hall M, Hinman RS. Osteoarthritis year in review 2015: Rehabilitation and outcomes. Osteoarthritis and Cartilage 2016; 24(1): 58–70.

7. Schaible HG. Mechanisms of chronic pain in osteoarthritis. Current Rheumatology Reports. 2012; 14(6): 549–56.

8. Fingleton C, Smart K, Moloney N, Fullen BM, Doody C. Pain sensitization in people with knee osteoarthritis: A systematic review and meta-analysis. Osteoarthritis and Cartilage. 2015; 23(7): 1043–1056.

9. Goldring MB, Otero M, Prumo DA, Dragomir C, Favero M, El Hachem K. et al. Papel das citocinas inflamatórias e anabolizantes no metabolismo da cartilagem: sinais e múltiplos efeitos convergem na regulação da MMP13 na osteoartrite. Eur Cell Mater. 2011; 21: 202-20.

10. Zhang Y, Nevitt M, Niu J, Lewis C, Torner J, Guermazi A, et al. Fluctuation of knee pain and changes in bone marrow lesions, effusions and synovitis on MRI: the most study. Arthr Rheum. 2011; 63(3): 1-13.

11. Lv H, Chen W, Yuwen P, Yang N, Yan X, Zhang Y. Multivariate analysis of factors related to radiographic knee osteoarthritis based on the comparison between football players and matched nonsportsmen. Int Orthopaedics. 2018; 42(3): 519–527.

12. Hill D, Boyd A, Board T. Management of symptomatic knee osteoarthritis in obesity: a survey of general practitioners’ opinions and practice. Eur J Orthop Surg Traumatol 2018.

13. Santos CL, Noronha DO, Camatti JR, Paixão AB, Xavier FB, Baptista AF. Exercício e eletroestimulação na dor, função e plasticidade cerebral de indivíduos com osteoartrite de joelho. O estado da arte. Rev Pesq em Fisioterapia. 2016; 6(1): 45–55.

14. Labus JS, Van Horn JD, Gupta A, Alaverdyan M, Torgerson C, Ashe-McNalley C, et al. Multivariate morphological brain signatures predict patients with chronic abdominal pain from healthy control subjects. Pain. 2015; 8(156): 1545–54.

15. Smallwood RF, Laird RA, Ramage AE, Parkinson, Lewis J, Clauw DJ, et al. Structural brain anomalies and chronic pain: A quantitative meta-analysis of gray matter volume. Journal of Pain. 2013; 14(7): 663–75.

16. Latremoliere A, Woolf CJ. Central Sensitization: a generator of pain hypersensitivity by Central Neural Plasticity. J Pain. 2010; 10(9): 895–926.

17. Graven-Nielsen T, Wodehouse T, Langford RM, Arendt-Nielsen L, Kidd BL. Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis and Rheumatism. 2012; 64(9): 2907–16.

18. Woolf CJ. Central Sensitization: Implications for the diagnosis and treatment of pain. Pain 2012; 152(3 Suppl): 1–31.

19. Kittelson AJ, Thomas AC, Kluger BM, Stevens-Lapsley JE. Corticospinal and intracortical excitability of the quadriceps in patients with knee osteoarthritis. Experimental Brain Research. 2014; 232(1): 3991–99.

20. Tarragó MGL, Deitos A, Brietzke AP, Vercelino R, Torres IL, Fregni F, et al. Descending Control of Nociceptive Processing in Knee Osteoarthritis Is Associated with Intracortical Disinhibition. Medicine (United States). 2016; 95(17): 1–10.

21. Garcia-Larrea LG, Peyron R, Mertens P, Gregoire MC, Lavenne F, Bonnefoi F, et al. Positron Emission Tomography during Motor Cortex Stimulation for Pain Control. Stereotactic and functional neurosurgery. 1997; 68: 141–148.

22. Parker RS, Lewis GN, Arroz DA, McNair PJ. Is Motor Cortical Excitability Altered in People with Chronic Pain? a Systematic Review and MetaAnalysis. Brain Stimulation - ELSEVIER 2016.

23. Peyron R, Faillenot I, Mertens P, Laurent B, Garcia-Larrea L. Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study. NeuroImage. 2007; 34(1): 310–321.

24. O’Connell NE, Marston L, Spencer S, DeSouza LH, Wand BM. Non-invasive brain stimulation techniques for chronic pain (Review). Cochrane Library. 2018; 4: 342.

25. Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L, et al. A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis & Rheumatism. 2006; 54(12): 3988–98.

26. O’Connell NE, Cossar J, Marston L, Varinha BM, Bunce D, Souza LH, et al. Transcranial Direct Current Stimulation of the Motor Cortex in the Treatment of Chronic Nonspecific Low Back Pain. Clin J of Pain. 2013; 29(1): 26–34.

27. DaSilva AF, Mendonça ME, Zaghi S, Lopes M, Santos MF, Spierings EL, et al. TDCS-induced analgesia and electrical fields in painrelated neural networks in chronic migraine. Headache. 2012; 52(8): 1283– 1295.

28. Rossi S, Sanrarnecchi E, Valenza G, Ulivelli M. The heart side of brain neuromodulation. Philosophical Transactions of the R Society A: Mathematical, Phyl and Eng Sciences. 2016; 374(2067): 20150187.

29. Conforto AB, Cohen LG, Santos RL, Scaff M, Marie SKN. Effects of Somatosensory Stimulation on Motor Function After Subacute Stroke. Leonardo. 2010; 24(3): 263–72.

30. Lefaucheur P, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014; 125(11): 2150–2206.

31. Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di lorio R, et al. Noninvasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application: An updated report from an I.F.C.N. Committee. Clinical Neurophysiology 2015; 126(6):1071–1107.4 Pain control in knee osteoarthritis MTP&RehabJournal. 2018; 16: 607

32. Knijnik LM, Dussán-Sarria JÁ, Rozisky JR, Torres IL, Brunoni AR, Fregni F, et al. Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: Systematic Review and Meta-Analysis. Pain practice : the official j of World Inst of Pain. 2015; 16(3): 294–304.

33. Mu Q. High Frequency Repetitive Transcranial Magnetic Stimulation Therapy For Chronic Neuropathic Pain: A Meta-analysis. Pain Physician. 2015; 18(6): E1029-46.

34. Bialosky JE, Bishop MD, Preço DD, Robinson ME, George SZ. The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model. Manual Therapy. 2010; 14(5): 531–38.

35. Teodorczyk-Injeyan JA, Injeyan HS, Ruegg R. Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J of Man and Phys Therapeutics. 2006; 29(1): 14–21.

36. Qinguang Xu MD, Bei Chen MD, Yuevi Wang MD, Xuezong Wang MD, Dapeng Han MD. The effectiveness of manual therapy for relieving pain, stiffness, and dysfunction in knee osteoarthritis: A systematic review and metaanalysis. Pain Physician. 2017; 20: 229–43.

37. Nice. Osteoarthritis: care and management. n. February, p. 8, 10, 2014. O’CONNELL, Neil E et al. Non-invasive brain stimulation techniques for chronic pain. Coch Database of Syst Reviews. 2014; 4:CD008208.

38. Vernon HT, Dhamni MS, Howley TP, Annett R. Spinal manipulation and beta-endorphin: a controlled study of the effect of a spinal manipulation on plasma beta-endorphin levels in normal males. J Manipulative Physiol Ther. 1986.

39. Degenhardt BF, Darmani NA, Johnson JC, Cidades LC, Rodes DC, Trinh C, et al. Role of osteopathic manipulative treatment in altering pain biomarkers: a pilot study. The J of the American Osteop Association. 2007; 107(9): 387–400.

5c79792f0e88251429da818d mtprehab Articles
Links & Downloads

Man. Ther., Posturology Rehabil. J.

Share this page
Page Sections