P6 - Pain Management of the Knee

Question 1

Tibiofemoral Joint Movements

Answer 1

• Flexion: Bending the knee, decreasing the angle between tibia and femur.
• Extension: Straightening the knee, increasing the angle between tibia and femur.
• Internal (Medial) Rotation: Inward rotation of the tibia relative to the femur.
• External (Lateral) Rotation: Outward rotation of the tibia relative to the femur.

Question 2

Accessory Movements in the Knee

Answer 2

• Spin: Rotational movement around a fixed axis (e.g., during internal/external rotation).
• Roll: A point on one surface meets new points on another surface (common during knee flexion/extension).
• Glide: One surface slides across another, maintaining contact at a single point.
• Distraction: Joint surfaces move apart, increasing joint space (used to relieve compression).
• Compression: Joint surfaces are pressed together, often to test joint stability.

Question 3

Patellofemoral Joint Movements

Answer 3

• Superior Glide: Upward movement of the patella.
• Inferior Glide: Downward movement of the patella.
• Medial Glide: Patella shifts towards the midline of the body.
• Lateral Glide: Patella shifts away from the midline.
• Medial Tilt: Patella tilts inward, rotating on a vertical axis.
• Lateral Tilt: Patella tilts outward, rotating on a vertical axis.

Question 4

Goals of Manual Therapy

Answer 4

• Increase or maintain range of motion (ROM)
• Reduce pain
• Prevent contractures
• Maintain integrity of soft tissue and muscle elasticity
• Increase venous circulation
• Boost synovial fluid production and cartilage nutrition
• Enhance kinaesthetic awareness

Question 5

Tibiofemoral Joint: Passive accessory Mobilisations

Answer 5

• AP (Anteroposterior) Movement: Apply pressure from anterior to posterior, commonly used to restore flexion.
• PA (Posteroanterior) Movement: Apply pressure from posterior to anterior, used to facilitate extension.

Question 6

Patellofemoral Joint: Passive Mobilisations

Answer 6

• Medial/Lateral Glides: Gently moving the patella side to side to improve mobility and reduce pain.
• Superior/Inferior Glides: Improving the tracking of the patella and ensuring proper mechanics during knee movements.

Question 7

Why combine exercise and mobilisations?

Answer 7

• Mobilisations help increase ROM and reduce pain, while exercises strengthen supporting muscles and improve functional outcomes.
• Combining both enhances tissue repair and prevents re-injury, as well as promotes joint stability.

Question 8

Key Techniques of manual therapy

Answer 8

• Joint mobilisations to improve ROM (e.g., tibiofemoral PA/AP glides).
• Soft tissue techniques to reduce swelling and pain (e.g., massage or myofascial release).
• Patella mobilisations to address maltracking.
• Exercises to address muscle imbalances and improve functional mobility.

Question 9

Common Objective Tests for the Knee

Answer 9

Lachman Test: To assess ACL integrity.
McMurray’s Test: For meniscus injury.
Varus/Valgus Stress Test: To assess MCL/LCL stability.
Patellar Apprehension Test: For patellar dislocation or instability.

Question 10

key considerations of manual therapy techniques in physiotherapy

Answer 10

• Link findings from subjective and objective assessments to treatment.
• Consider patient goals and hobbies (e.g., walking, sports) when prescribing exercises.
• Use evidence-based techniques to justify interventions.