Repeated Knee Extension for Knee Pain
File this under: almost too crazy/easy to work! Like most MDT based resets, repeated loading into knee extension often helps rapidly with knee pain.
Reminder: terminology post here.
One of the mistakes clinicians make with the SFMA is forgetting to address the proximal DP, or the reason why the patient is in your office in the first place. Don't just tackle every distal DN you can find, just because they're easy wins. The biggest sell is getting a rapid response on the proximal DP, and then you can address distal DNs to make the most of movement and symmetry.
For the knee, a quick screen I perform is a supine passive end range extension. This should normally be about 10 degrees or so passively, and have a firm end feel (not bony like the elbow). A pattern you may often find in "insert pathoanatomical knee diagnosis here" that had insidious onset, or at least atraumatic, is that the involved side will have limited or very little knee hyperextension compared to the uninvolved side. Remember a rule of a directional preference based reset, is that the direction to repeatedly load is often the direction contrary to what the patient is already doing ad nauseam.
I also think certain directions, like knee extension have an end range, as in there is an approximation of surfaces, versus flexion, which is often unloading the capsule with a soft end feel. The input of end range mechanorecption is what resets the CNS alarm, thus increasing pain thresholds, and allowing the patient to "bank" more movement prior to nociception. At least, that's why I think one direction works over another.
After finding the pattern of lost extension, I normally have the patient check their limited functional test, like a squat, lunge, step, etc... then I perform 10-30 repeated end range loading into passive extension in the supine position. The first few, may be uncomfortable and limited, but should rapidly increase in range if this is going to work. The fast increase in ROM is a great indication you have a rapid responder on your hands, and you can breathe an internal sigh of relief. #IASTM to the lateral upper thigh patterns may also help with getting end range more comfortably. Wrapping EDGE Mobility Bands, or something similar around the distal thigh and proximal calf may also help modulate the discomfort.
Here is a quick vid of how I demonstrate this to patients.
The real advantage to starting out with a treatment like this is you just lead the horse to water with a simple treatment they can replicate at home to keep the window of improvement open. That's buy in for you and your business!
Keeping it Eclectic...