Two Easy Self Assessments for Knee Pain Patients | Modern Manual Therapy Blog

Two Easy Self Assessments for Knee Pain Patients

I recently did an online consult of a patient with chronic knee pain of 6 month duration.

The onset of pain started when she began dancing and yoga. Most of the dancing involved rotatory movements and yoga was mostly single limb stance. She had been seeing a PT and done some personal training also at that facility. Her orthopaedic surgeon thankfully did not want to operate, but focused on anti-infllammatories as needed. Her interventions were
  • anti-inflammatories, which relieved pain until she danced or did yoga again
  • core strengthening which seemed to consist of general conditioning and balance work

Her PT referred her for an online consultation. The first part of the consultation involved a good dose of Pain Science Education, which focused on
  • pain as a normal response to perceived threat
  • the "arthritis'' in her knee seen on x-rays/MRI was most likely equal on pain free side
    • her left and right knee are the same age
  • if we restore her ability to rotate/load the left knee without the perception of threat input, the output will change as well
Since this was an online consult, you have to improvise in terms of assessment, however any good HEP will end up showing not only self treatment but self assessment for baselines. Her movement assessment found
  • sev loss of hip IR on the left
  • mod loss of tibial IR on the left
  • lunge pattern on left showed marked genu valgus compared to right

Here are the self assessments I showed her for hip motion and tibial motion baselines. They are both easy and give your patient a quick way to pre and post test motion, which lets them know when to re-test function - after motion improves to more symmetrical.

Quadruped Hip Rotation
  • this was mainly to test hip IR
  • patient is in quadruped with hips/knees at 90-90
  • have them internally rotate the hip and you see from the front (and they can turn and look as well) how far laterally one foot goes compared to the other

Seated Tibial IR
  • this is covered in this post
  • patient seated at 90-90
  • feet stay flat
  • without the knees dropping inward or outward, turn the feet out and then in (expecting the more common pattern of loss of IR for knee pain)
  • WNL is 10 degrees turned both in and out

Both of these self assessments are a quick and easy way to show common motion asymmetries to your patients and give them baselines to know whether or not they should more diligent with their resets.

Keeping it Eclectic....


  1. As I attempted the hip IR screening on myself I noticed something. I moved my R hip first and assessed my mobility, then with the R still in IR I moved the L into IR and noticed a pretty severe loss of IR. I thought that just wasn't right so I reset my position and attempted to do my L first and found that I had much improved IR, I then performed my R side and noted severe limitations. I then did both at the same time and noted what I would call moderate ROM limitations bilaterally. After trying this multiple times before I posted this to you it appears that whatever side I moved first was found to be WNL with the second side indicating more limitations. It appears it may be possible that if we put the ER muscles/structures on stretch on one side it may limit the mobility of the ER on the contralateral side as we sort of lock the sacrum and pelvis towards the side tested first, indicating a loss of IR which may not be a true loss. Does this happen to you? I'm curious what would happen if you moved your R side first, then your left, if it would still demonstrate decreased IR ROM on your previously injured side.

  2. That is most likely true and the patient who performed on herself noticed that as well. I do not normally instructed to do it bilaterally any more than you would measure hip IR/ER in sitting bilaterally. She thought the limitation in her left was because she was testing it after testing her right and at the same time. However, when she tested her left (involved) side only, it was still very limited, just not quite as much as when her right side was also in IR. Hope this makes sense!

  3. Hi Dr E, what would you suggest to loosen up the hip? And why does it seem that the hip external rotators are always tight? I can't figure it out. Your input would be greatly appreciated.

  4. It's not that the hip external rotators are tight, more that in terms of variability, most people do not perform repeated hip internal rotation. They sit in external rotation/flexion etc. Try this to loosen them up then just have them perform repeated hip IR in hooklying or sitting repeatedly throughout the day to keep them moving.