KNEE MOBILIZATION CASE SCENARIO

Diagnosis: Post Fracture of the Left Tibial

Condlye

Problem

•Limited motion of the left knee

History

• A 29 year old male policeman was involved in a MVA three months ago. He under went surgery of the left knee for a left tibial plateau fracture.

History

• Following surgery his knee was immobilized for a period of six week allowing for healing. He has been referred to physical therapy for rehabilitation of the knee.

Clinical Presentation

• Patient demonstrates moderate loss of both active knee flexion and extension.

• There is residual swelling of the left knee with moderate weakness and atrophy.

• Pain is intermittent rated 2/10

:

Immediate Goal

• To regain motion of the left knee

• Began to strengthen the knee• Treatment Choices

– Joint mobilization – Soft tissue stretching– Strengthening exercises open and close chain

Arthokinematics of the knee

• General – A. Joint comprising the knee complex– a. patella femoral– b. tibial femoral– c. tibial fibula

– C, Loss pack position» Patella 0 to 10 degrees of knee flexion» Tibia –femoral joint 10 – 20 degree of flexion

• D. Capsular pattern» Flexion > extension.

– .Arthokinematic– . of the knee

– Knee moving into extension (open chain)

The patella will glide superiorly – Tibia will glide anteriorly on femur

– The medial condyle of tibia will glide from a posterior to anterior direction.

– Knee moving into flexion ( open Chain)– The patella will glide posteriorly on the femur– Tibia will glide posteriorly on femur– At approximately 100 degrees of flexion an anterior tilt of tibia occurs on femur.– The medial condlye of tibia will glide from anterior to posterior direction

• The lateral tibial condyle will glide from a posterior to anterior direction.

Arthokinematics of the knee

•B. Active Movements–Flexion and Extension of the tibia on the femur

–As the knee goes into flexion there is an associated internal rotation and adduction of the tibia

–As the knee goes into extension there is an associated external rotation and abduction of the tibia

Selection of Knee Techniques

• Reminder ! the patient has limitation in both flexion and extension of the knee.

• Pain ? Is it a major factor?• What grades of movement would you try to achieve within the first visit.?

Anterior / Posterior Tibial Glide

• Anterior Glide – Component motion for flexion

• Posterior Glide– Component Motion for extension

• Both procedures effect nutrition to articulator structures

Posterior Glide of Tibia on Femur

• Alternative technique for knee flexion

Anterior Medial Glide of Tibia on Femur

• Technique used to improve external rotation and knee extension.

Anterior Lateral Glide of Tibia on Femur

• Technique to improve tibial internal rotation. A component motion necessary for proper knee flexion.

Superior Glide of Patella

• Joint affected- Patella femoral

• Superior glide to increase knee extension

• Affects nutrition of the articulator structures

Inferior Glide of Patella

• Technique for improving knee extension.

Medial Glide of Patella

& Lateral Glide of

Patella• Used to improve knee flexion and extension.