{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:23:26Z","timestamp":1787027006295,"version":"build-2736575974"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"\n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Following MT intervention, the intervention group demonstrated significant reductions in WOMAC pain scores (13.04\u2009\u00b1\u20094.39 vs. 5.36\u2009\u00b1\u20092.40;\n P<\/jats:italic>\n \u2009&lt;\u20090.001), increased 6-MWT distance [320.44\u2005m [95% CI: 283.68\u2013357.20] vs. 612.28\u2005m [95% CI: 594.42\u2013630.14];\n P<\/jats:italic>\n \u2009&lt;\u20090.001], and diminished inter limb asymmetry in PFS (54.52\u2009\u00b1\u200919.35\u2005N vs. 15.92\u2009\u00b1\u200911.00\u2005N;\n P<\/jats:italic>\n \u2009&lt;\u20090.05). 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n MT delivers significant short-term clinical benefits for elderly patients with unilateral mild-to-moderate KOA (Kellgren-Lawrence grades 0\u20132), including effective pain relief and improved walking ability, potentially through restoring proprioceptive sensitivity and modulating intermuscular balance.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpain.2026.1749582","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:54:14Z","timestamp":1772088854000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Manual therapy improves pain and walking function in geriatric knee osteoarthritis via proprioceptive mediation"],"prefix":"10.3389","volume":"7","author":[{"given":"Bowen","family":"Zhu","sequence":"first","affiliation":[{"name":"Institute of Manual Therapy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]},{"name":"Department of Traditional Chinese Massage, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sipeng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Massage, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuaipan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Massage, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingguang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Institute of Manual Therapy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]},{"name":"Department of Traditional Chinese Massage, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Fang","sequence":"additional","affiliation":[{"name":"Institute of Manual Therapy, Yueyang Hospital of 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