Symptomatic joint degeneration is a common chronic musculoskeletal disorder worldwide. The literature has noted that some clinicians find treating this condition “technically challenging,” while others find it to be “unchallengingly routine.” We believe that all clinicians treating symptomatic joint degeneration should have a robust understanding of the mechanobiological interactions between the synovial lining, synovial cells, synovial fluid, articular cartilage, and subchondral bone. This four-part narrative review describes how inner lining synovitis and cellular changes in the subchondral region, including the development of bone marrow edema, are symptom generators in some patients with various grades of joint degeneration. This review suggests that physical therapists (PTs) should acquaint themselves with the concept of mechanotransduction and more fully consider cellular mechanosensitivity and mechanoresponsiveness as exercise loading and manual interventions loads are placed upon joints with degenerative change. We call for additional research efforts in the area of protocol development for low-load exercise intervention and between PTs and physicians who may have access to laboratory facilities and imaging equipment. This research could allow for both direct and indirect assessment of intra-articular pressure, synovial fluid, and bone marrow edema after the application of therapeutic exercise and joint mobilization.

Background: Loss of sagittal balance can lead to excessive thoracolumbar (TL) kyphosis, which is a postural impairment characterized by an increase in kyphotic curvature in these two regions of the spine. Excessive TL kyphosis has been shown to adversely affects quality of life and activities of daily living (ADL). Objectives: This study aimed to investigate immediate spinal motion and resultant postural changes after the application of single thoracic extension mobilization. This was compared to the application of two extension mobilizations, one of which was applied to the lumbar region in the second group of patients with excessive TL kyphosis. Design: Quasi-experimental study. Methods: A total of 53 participants (71.6 years, 20 male/33 female) were recruited. All participants had greater than 40° of TL kyphosis, as measured with a single gravity-dependent inclinometer positioned over the T1 spinous process. One group received thoracic extension mobilization only, whereas the other group received both thoracic and lumbar extension mobilization. Results: Both groups demonstrated an improvement (decrease) in the thoracolumbar kyphosis angle. The group that received thoracic mobilization alone demonstrated a 6.46° change (P<0.0001), while the group that received both mobilizations demonstrated a change of 11.96° (P<0.0001). Combined mobilization applied to both the thoracic and lumbar regions resulted in a significantly greater change (reduction) in TL kyphosis (5.50°, P<0.0001). Conclusion: The results demonstrate that the addition of a second mobilization to the lumbar region results in greater active TL extension and reduced TL kyphosis. Clinicians treating patients with excessive kyphotic curvature should be mindful of the contribution of the lumbar region to loss of sagittal balance. The addition of this simple manual mobilization to the lumbar region appears to yield better short-term improvements in patients with overly kyphotic spinal posture.