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The Journal of Pain, Vol 11, No 2 (February), 2010: pp 179-185
Available online at
Heightened Flexor Withdrawal Response in Individuals With Knee
Osteoarthritis Is Modulated by Joint Compression and Joint
Mobilization
Carol A. Courtney, Paul O. Witte, Samuel J. Chmell, and T. George Hornby
University of Illinois at Chicago, Chicago, Illinois.
Abstract: Patients with chronic pain often present with hyperalgesia, possibly due to hyperexcit-
ability of nociceptive pathways. The aim of the present study was to investigate alterations in flexor
withdrawal reflex (FWR) excitability in individuals with knee osteoarthritis (OA) and the potential ef-
fect of specific physical inputs or therapeutic interventions (ie, joint compression and mobilization)
on these behaviors. Ten subjects with and 10 without knee OA (age 45–75) were recruited. The
FWR was examined utilizing suprathreshold, noxious electrocutaneous stimuli applied at the medial
foot. Surface electromyographic (EMG) was recorded from the tibialis anterior (TA) and biceps femo-
ris (BF), and peak joint torques recorded at the hip, knee, and ankle. FWR threshold was ascertained
and responses at 2 threshold recorded after the following conditions: a maximal, volitional, joint-
compression task, a sham hands-on intervention, and a Grade III oscillatory joint-mobilization inter-
vention. A decreased threshold-to-flexor withdrawal response was found in the OA vs control group
(P .01). EMG and joint-torque FWR responses were further augmented in the OA group following
the maximal joint-compression task (P .05), yet remained unchanged or diminished in controls. Joint
mobilization, but not sham intervention, reduced
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