Knee Mobilisations

Original Editor - David Drinkard

Top Contributors - Admin, Reem Ramadan, Nupur Smit Shah, Angeliki Chorti, David Drinkard, Laura Ritchie, Dan Rhon, Irene Leahy, Kai A. Sigel, Kim Jackson, Mariam Hashem and Evan Thomas

Introduction

Knee mobilizations may be beneficial for individuals with a variety of conditions, including post-operative rehabilitation and knee osteoarthritis (OA).

Several studies have used knee mobilizations for the treatment of knee pathology. In OA, the two with the longest follow-up, out to one year, include:

• Knee OA - Deyle et al. 2000.  Manual therapy and exercise were compared to placebo ultrasound in 83 patients with knee OA. Patients underwent treatment twice a week for 4 weeks and were followed up for one year. There was a clinically and statistically significant greater improvement in the manual therapy and exercise group compared to the placebo ultrasound group at four weeks and the improvements were maintained at one year. The authors used an impairment-based approach that included mobilizations of the tibiofemoral joint, patellofemoral joint, proximal tibiofibular joint, and surrounding soft tissue. Mobilizations to the lumbar spine, hip, and ankle were also applied as required.

• Knee OA - Deyle et al. 2005. Manual therapy and home exercise were compared to a home exercise program in 134 patients with knee OA. Both interventions provided an improvement in pain and function but at the one-year mark, the manual therapy and exercise group were less likely to be taking medications for their OA and were more satisfied with the overall outcome of their treatment. They used the same techniques as in the first trial.

The effectiveness of knee mobilizations in knee OA have also been lately investigated in a systematic review by Weleslassie et al. 15 RCTs with 704 participants were included.Pain reduction and functional improvement were significantly better than the control groups in most studies.

Tibiofemoral articulations

The tibial plateau is concave and it articulates with convex femoral condyles.

Resting position

25 degrees of knee flexion

Treatment plane

It is along the tibial plateaus

Stabilization

The femur bone is stabilized.

Tibiofemoral joint distraction

The tibiofemoral joint distraction is done in three different positions: Prone lying, Supine lying, and high sitting position.

Indications

• Initial treatment and general mobility of the patient
• Pain control

Tibiofemoral Distraction(High sitting position, Supine lying, and Prone lying )

Patient position/Hand placement/Mobilizing force

The patient is positioned in prone with thigh fixated to the table via the use of a stabilizing belt. The therapist grasps the involved leg just proximal to the malleoli and provides a distraction force(along the long axis of the tibia) by leaning backward along the line of the tibia. This technique is particularly effective for pain control; other positions may be more beneficial for higher-grade mobs to increase general joint play and flexion. An alternative position is performed with the patient sitting with the leg hanging off a table or in supine lying position.

Anterior Glide

Anterior tibial glides can be performed several ways but are often (and most functionally) performed with the patient supine and the lower leg propped, reaching maximal or near-maximal extension. The proximal tibia is stabilized with one hand and the mobilizing hand is placed on the distal femur. A posteriorly-directed force is applied directly downward through the distal femur. This mobilization is useful for helping to gain joint play necessary for obtaining terminal extension of the knee, particularly when a patient only lacks a few degrees to reach full extension.

Posterior Glide

The patient is positioned in supine with the knee slightly flexed and a prop placed under the distal femur. The stabilizing hand is used to prop the distal femur and the mobilizing hand is placed over the proximal tibia just below the tibial tuberosity. The mobilization itself is performed by a force perpendicular to the line of the tibia. This technique is useful for obtaining joint play necessary for knee flexion. Although this technique is often used in the closed-packed position, it can also be performed with the knee flexed near the level of restriction, similar in position to the posterior drawer test for the PCL.

Rotational Glides

Internal and external rotation glides are useful for gaining joint play for knee flexion and extension, respectively. These glides can be performed at various points in the normal ROM of the knee with the patient positioned in supine. The stabilizing hand grasps the distal femur and the mobilizing hand grasps the heel of the patient's foot. The ankle is maximally dorsiflexed so that rotational motion is applied to the rotating tibia and not at other joints more distally. The foot is either rotated medially or laterally, depending on the mobilization preferred (internal or external rotation) and at the range where restriction may be apparent.

Patellofemoral Glides

Patellofemoral glides are used when restriction of the patellofemoral joint causes pain or decreased overall knee ROM/function. Medial/lateral glides are utilized with the patient in supine with the knee slightly flexed. To provide a medial glide, the therapist utilizes both hands to press on the inferior and superior aspects of the medial patella and deliver a force to glide the patella in a lateral direction. Conversely, contact points on the lateral patella are used to produce a medial glide. Superior and inferior glides are used for joint play and patellar motion necessary for extension and flexion, respectively. Similar to the medial/lateral glides, joint surfaces on the side of the patella opposite the direction of mobilization are used. For example, inferior surfaces are used to mobilize the patella in a superior direction and vice versa.