Knee Manual Therapy PDF

Manual Therapy Knee JUSTIN TRENT UNIVERSITY OF SAINT MARY WHY/WHEN/HOW DO WE APPLY MANUAL THERAPY TO BEST HELP OUR PATIENTS? Intervention The Path Ahead 1 Soft Tissue Techniques 2 Patellofemoral Techniques 3 Tibiofemoral Techniques 4 Proximal Tibiofibular Techniques Part One: Soft Tissue Techniques...

Manual Therapy Knee JUSTIN TRENT UNIVERSITY OF SAINT MARY WHY/WHEN/HOW DO WE APPLY MANUAL THERAPY TO BEST HELP OUR PATIENTS? Intervention The Path Ahead 1 Soft Tissue Techniques 2 Patellofemoral Techniques 3 Tibiofemoral Techniques 4 Proximal Tibiofibular Techniques Part One: Soft Tissue Techniques General Soft Tissue Techniques … These technique are used for patients experiencing myofascial pain, fascial tightness, trigger points, and/or excessive muscle tightness. Improve myofascial mobility. Decrease myofascial pain. Prepare the region for additional mobilization. Noninvasive: ü Effleurage and Petrissage ü Bend and Stretch ü Ischemic Compression ü Myofascial Release Holds ü Scar Massage ü Instrument-assisted Soft Tissue Mobilization Invasive: ü Dry Needling (Deep/Superficial) Quads, Hamstrings, ITB, Gastroc, Adductors Considerations How is it performed? What is the intent? What indicated this need? What comes next? PRACTICE Effleurage and Petrissage Bend and Stretch Ischemic Compression Myofascial Release Holds Instrument Assisted Massage Cross-Friction Massage This technique is used for patients experiencing tendinopathy … Improve Recollagenation Discourage Neural Ingrowth Decrease Pain ü The patient is positioned in supine or sitting. ü Cross-friction force is applied in a one-directional motion across the tendon. ü Force should be mildly irritable but very tolerable for the patient. ü Perform this technique ~2 minutes at one intensity and increase intensity for another 2 minutes if there was local pain reduction in the area Considerations How is it performed? What is the intent? What indicated this need? What comes next? PRACTICE Cross-Friction Massage Part Two: Patellofemoral Techniques Patellofemoral Mobilization … These techniques are used for patients experiencing patellofemoral restriction. Improve capsular mobility. Improve Range of Motion. ü The patient is positioned in supine with a towel under their knee. ü Mobilization force is applied similarly to that of joint play to the patella: ü Superior = Promotes Extension ü Inferior = Promotes Flexion ü Medial Glide = Improves Patellar Tracking ü Medial Tilt = Improves Patellar Tracking ü Perform this mobilization for 30-45 seconds 4x, or until capsular change ü Finish the technique with neuro-muscular re-education ü Agonist à Antagonist à Agonist Considerations How is it performed? What is the intent? What indicated this need? What comes next? PRACTICE Patellofemoral Mobilization Superior Glide Inferior Glide Medial Glide Medial Tilt Part Three: Tibiofemoral Techniques Tibiofemoral Extension Mobilization … This technique is used for patients experiencing tibiofemoral restriction in extension. Improve capsular mobility. Improve Range of Motion. ü The patient is positioned in supine. ü Stabilization is provided by a towel or your hand on the proximal posterior tibia. ü Mobilization force is applied in a posterior direction to the distal femur ü Perform this mobilization for 30-45 seconds 4x, or until capsular change ü Finish the technique with neuro-muscular re-education ü Agonist à Antagonist à Agonist Considerations How is it performed? What is the intent? What indicated this need? What comes next? PRACTICE Tibiofemoral Extension Mobilization Tibiofemoral Flexion Mobilization … This technique is used for patients experiencing tibiofemoral restriction in flexion. Improve capsular mobility. Improve Range of Motion. ü The patient is positioned in supine with their knee flexed. ü Stabilization is optional and may be provided to the femur or distal tibia. ü Mobilization force is applied in a posterior direction to the proximal tibia ü Perform this mobilization for 30-45 seconds 4x, or until capsular change ü Finish the technique with neuro-muscular re-education ü Agonist à Antagonist à Agonist Considerations How is it performed? What is the intent? What indicated this need? What comes next? PRACTICE Tibiofemoral Flexion Mobilization Part Four: Proximal Tibiofibular Techniques Tibiofibular Posterior Mobilization … This technique is used for patients experiencing tibiofemoral restriction in extension, reduced tibial external rotation, or peroneal nerve irritation. Improve Knee Extension. Improve Tibial External Rotation. Reduce Peroneal Nerve Irritation. ü The patient is positioned in supine with a towel under their knee. ü Mobilization force is applied in an anterior direction to the proximal tibia with your inside hand. ü Mobilization force is applied in a posterior-medial direction to the proximal fibula with your outside hand. ü Perform this mobilization for 30-45 seconds 4x, or until capsular change ü Finish the technique with neuro-muscular re-education ü Agonist à Antagonist à Agonist Tibiofibular Anterior Mobilization … This technique is used for patients experiencing tibiofemoral restriction in flexion, reduced tibial internal rotation, prior ankle inversion sprain, or peroneal nerve irritation. Improve Knee Flexion and/or Tibial Internal Rotation. Improve Mobility s/p Inversion Trauma. Reduce Peroneal Nerve Irritation. ü The patient is positioned in quadruped. ü Stabilization force brings the foot and ankle into dorsiflexion. ü Mobilization force is applied in an anterior-lateral direction to the proximal fibula. ü Perform this mobilization for 30-45 seconds 4x, or until capsular change ü Finish the technique with neuro-muscular re-education ü Agonist à Antagonist à Agonist Considerations How is it performed? What is the intent? What indicated this need? What comes next? PRACTICE Tibiofibular Posterior Mobilization Tibiofibular Anterior Mobilization WHY/WHEN/HOW DO WE APPLY MANUAL THERAPY TO BEST HELP OUR PATIENTS? Any questions? Q&A session