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Knee lab

KEY RESOURCE:

INTRO TO MANUAL THERAPY RECORDED PRESENTATION

Clinical Patterns Case #3: Amir

Amir is a 43 year-old male, recreational walker. He presents with reports of right medial knee pain that has increased over the last 4 months. He has had previous episodes of knee pain on the outside of the knee that was diagnosed by you as iliotibial band syndrome 1 year ago. Of his previous exercises, he has only continued the foam rolling routine that you gave him, and that helps to manage the ITB symptoms. He recently had a virtual consult with his family doctor who sent him for xrays which revealed mild joint space narrowing on the medial and lateral tibiofemoral joints, with mild subchondral sclerosis of the patellofemoral and medial tibiofemoral joints. He is married with no children, and his wife and him enjoy completing virtual walking challenges. Part of his motivation for walking is to try and address his high blood pressure, high triglycerides, and high glucose levels. They are currently working through the Inca Trail challenge and so he wants to make sure he can continue to walk so he can spend time with his wife and for his own health.

What information would increase your

suspicion of a meniscal tear? OA? PFPS?

Assessment category Meniscal tear OA PFPS Subjective info Posture/observation Active Mobility: Functional tests AROM Passive Mobility: Passive physiological Passive accessory Muscle: MMT LTT Palpation Other

Customized Scan for Amir

What elements of the scan would be important to include for Amir. Justify your choices. What condition(s) are you trying to rule out with the scan in this case? Perform a customized scan for Amir on your lab partner in 5 minutes

Implications of ‘posture’ on clinical reasoning process

1. Establish relationship of static/ dynamic posture on presenting symptoms
2. Consider the ‘level of concern’ or ‘risk’ of static/dynamic postures contributing to overall presentation
3. Physical Exam: Observation of static/dynamic posture informed by patient history
4. Devise specific ‘modifications’ to static/dynamic posture to determine the effect of changes on symptoms
5. Determine relevant and reproducible physical assessments to establish effect of treatment over time

Observation and Functional Tests

What would you like to focus on?

Amir is a 43 year-old male, recreational walker. He presents with reports of right medial knee pain that has increased over the last 4 months. He has had previous episodes of knee pain on the outside of the knee that was diagnosed by you as iliotibial band syndrome 1 year ago. Of his previous exercises, he has only continued the foam rolling routine that you gave him, and that helps to manage the ITB symptoms. He recently had a virtual consult with his family doctor who sent him for xrays which revealed mild joint space narrowing on the medial and lateral tibiofemoral joints, with mild subchondral sclerosis of the patellofemoral and medial tibiofemoral joints. He is married with no children, and his wife and him enjoy completing virtual walking challenges. Part of his motivation for walking is to try and address his high blood pressure, high triglycerides, and high glucose levels. They are currently working through the Inca Trail challenge and so he wants to make sure he can continue to walk so he can spend time with his wife and for his own health.

Joint Mobility Testing

Mobility Tests

Active ROM: flex, ext

Passive ROM

• Uniplanar: flex, ext, rotation
• Combined movement

1. Ext / Abd

2. Ext / Add

3. Flex / Abd / MR

4. Flex / Add / LR

I II III IV V TR1 TR Geoffrey Maitland Mobilizations are graded and oscillated Grade I: Small amplitude, no tissue resistance Grade II: Large amplitude, no tissue resistance Grade III: Large amplitude, into tissue resistance Grade IV: Small amplitude, into tissue resistance Grade V: Small amplitude, quick thrust at end of available motion (manipulation)

Selecting PAM assessments

You are applying the concave-convex rule to assessing the passive accessory motions (joint glides) at the tibio-femoral joint in a patient with - 5 0 of passive knee extension. What passive accessory movement is associated with this ROM loss?: a. Anterior glide of the tibia b. Posterior glide of the tibia c. Anterior glide of the femur d. Lateral glide of the tibia e. Internal rotation of the tibia What would Kaltenborn do?

Initiating Treatment

Limited Flexion Limited Abd Osteokinematic (AROM/PROM) Arthrokinematic (PAM) Myofascial (muscles that affect the movement of the joint)

How would you address the following knee restrictions?

Initiating Treatment

WHAT ARE THE FACTORS TO CONSIDER?