One of my favorite and easily applied techniques for knee pain that works wonders with PFS!
- open chain - supine
- closed chain, standing, single leg squat, lunge, double leg squat, step up or down
- the involved LE is the forward leg or the WB LE for treatment.
- open chain, standing on the pt's involved side LE
- closed chain, kneeling or squatting on the involved side LE
- grasp on proximal tibia medially and laterally
- take up all slack and rotate tibia internally for the entire movement - not just the flexion part
- pt flexes and extends knee in open chain with PT guidance
- assist with overpressure at end range
- for closed chain have the pt perform a normally limited or painful functional movement such as a squat, single leg squat, step up/down, or lunge
- usually done in 2-3 sets of 10
- it should be 100% pain free
- variations - if not completely pain free - a stretch is ok
- use more force or less force
- simultaneously externally rotate the femur (or only)
- try varus/valgus stress
- externally rotate the tibia - rare
- try to change the direction of the rotation slightly superior, slightly inferior
- any limits in knee flexion/extension due to knee pain or restrictions
- limits in closed chain function
The pt may be easily taught how to maintain this on their own as long as they can reach their own tibia. This works well in combination with IASTM to the ITB, hip and ankle mobilizations, as well as core and gluteus medius strengthening.