So I'm just going to go over some of the ways that the DIAL article comparing corticosteroid injections versus manual therapy, some of the ways that they worked on knee flexion range of motion. Go ahead and scoot over towards me a little bit, Claudia. you. So essentially what I want you thinking about is instead of just thinking about just passive knee flexion or some sort of end range mobilization in this range, I think a lot of these patients have a degree of angulation to their leg varus and valgus just based off like that's kind of what knee osteoarthritis is. And maybe they're reporting a pretty noxious like pinching type of discomfort that's keeping them from being able to do the range. So what I would suggest is, you know, potentially taking them into some degree of hip either AB duction or hip AD duction while going into flexion. Does that produce a different type of sensation? Does that allow you to get further into the range of motion what's the response on again the goal being just regular knee flexion also considering like tibial internal rotation potentially with hip adduction or hip uh sorry tibial external rotation with abduction might be something to just investigate and see if that feeling that they're getting with just straight passive knee flexion, how does that change when you're adding some of those components of where the femur is relative to the tibia? Obviously, if you're taking them into those positions and the restriction is sooner and it's more painful, I don't know necessarily that's what we're trying to go for. But the thought is, if just straight plane range of motion is not necessarily getting you a great result. Does potentially adding in some of those other directions potentially allow you to bypass that restriction that allows you potentially to quote unquote mobilize the knee a little bit more and then you're going to you're going to come back to your test retest of the knee flexion range and say hey was that more effective do I need to do more of that activity to be able to improve the knee range and then you can go back to just normal straight plane knee flexion. Another technique to just consider is a popliteal wedge where you're kind of fulcruming the tibia femoral joint, maybe in theory providing a posterior to anterior glide of the tibia into knee flexion. Does that change the sensation, the noxious sensation that the patient is reporting with knee flexion? Does that allow you to immobilize the knee into more knee flexion? And then, of course, again, you would go back to your range of motion testing, did that improve by a certain degree? If so, maybe instead of just giving a traditional like wall slide or heel slide, maybe you then create a popliteal wedge behind the knee for them to do their range of motion activities as kind of like a paired intervention between your manual activities and then your exercise.

Tibiofemoral Mobilizations into Flexion

From William Seymour April 24, 2025

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Tags: physical therapy

Department Name: Physical Therapy
Date Established: April 23, 2025
Appears In: UDPT OMPT Fellowship Program

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