Original Editor - David Drinkard
Knee mobilizations may be beneficial for individuals with a variety of conditions, including post-operative rehab and knee osteoarthritis (OA). Several studies have used knee mobilizations for treatment of knee pathology. The two with the longest follow-up, out to one year, include:
1. Knee OA - Deyle 2000. Manual therapy and exercise was compared to placebo ultrasound. Patients were followed up to one year. There was a significantly 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. They used an impairment-based approach that included mobilizations of the tibiofemoral joint, patellofemoral joint, proximal tibiofibular joint, and surrounding soft tissue.
2. Knee OA - Deyle 2005. Manual therapy and exercise were compared to a home exercise program. Both interventions provided an improvement in pain and function but at the one year mark, the manual therapy and exercise group was significantly better. They used the same techniques as in the first trial.
The patient is positioned in prone with thigh fixated to table via use of a stabilizing belt. The therapist grasps the involved leg just proximal to the malleoli and provides a distraction force 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.
Anterior tibial glides can be performed several ways but are often (and most functionally) performed with the patient supine and 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.
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.
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 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.
- Deyle, 2000, Ann Intern Med. http://www.ncbi.nlm.nih.gov/pubmed/10651597
- Deyle, 2005, Phys Ther http://www.ncbi.nlm.nih.gov/pubmed/16305269
- orthopedicPT's channel. Tibiofemoral Distraction. Available from: http://www.youtube.com/watch?v=ZIcqGUwT4oQ [last accessed 22/09/14]
- orthopedicPT's channel. Posterior Glide Femur on Tibia. Available from: http://www.youtube.com/watch?v=jk71NUtI748 [last accessed 22/09/14]
- ortholabOSU. Tibiofemoral Posterior Glide for Flexion. Available from: http://www.youtube.com/watch?v=jIjLUcT-oug [last accessed 22/09/14]
- Physical Therapy Nation. Medial Tibia Rotational Mobilization. Available from: http://www.youtube.com/watch?v=AZCIPwyc3XM [last accessed 22/09/14]
- MSURehabMed. Michigan State University: Patellar Mobilizations. Available from: http://www.youtube.com/watch?v=FcU7Kc1FtnI [last accessed 22/09/14]