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BOSU® ball squat. (a). Starting position, (b). While squatting, the patient attempts to keep the platform parallel to the ground
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Quadriceps weakness is a common finding following knee injuries or surgery, and can be associated with significant functional limitations. This weakness or muscle inhibition may be due to central inhibitory mechanisms, rather than local peripheral dysfunction. Lumbopelvic manipulation has been shown to effect efferent muscle output by altering noci...
Context in source publication
Context 1
... subject reported symptoms remained unchanged at the first follow up visit. Following re-assessment, a five-minute self-selected pace warm up on a bike without added resistance was performed. After- wards, lumbar manipulation as described by Cle- land et al 38 was directed at the L3 segment, with the subject in right side-lying, as the left was the symptomatic extremity ( Figure 2). Knee extension force was measured with a hand-held dynamometer before and after the thrust technique. Baseline quad- riceps strength was 73.2 lbs, which increased to 78.8 lbs immediately following the lumbar manipula- tion treatment. The subject then performed a series of exercises combining both dynamic balance and strength training of the left knee extensors as well as the left hip abductors and extensors. These included single leg mini squats in a mirror in order to facil- itate knee position awareness as well as eccentric quadriceps loading, decline squats (Figure 3) to increase quadriceps recruitment, single leg deadlifts to increase gluteal strength and stability in single leg stance, and walking lunges to facilitate quadri- ceps recruitment as well as lumbopelvic stability. Bilateral squats on a BOSU® ball ( Figure 4) were per- formed with cues to keep the platform parallel to the ground, in order to encourage equal weight bearing and balance. The subject's HEP was modified to pri- marily focus on the eccentric phase of squats and leg press in order to increase quadriceps loading. Additionally, the patient was educated to attempt to control sagittal plane motion at the knee complex during exercises. The details of the subject's exercise program can be seen in Table ...
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Study Design Randomized controlled trial. Background Many clinical practice guidelines endorses that both manual therapy and exercise are effective treatment options for patients with low back pain. To optimize the effects of the treatments recommended by the guidelines, a new intervention known as kinesio Taping is being widely used in these patie...
Citations
... The lumbosacral manipulation and knee exercises are the most widely used treatment in physical medicine to treat PFPS that carry no major side effects (8)(9)(10)(11). Manipulative therapy was first introduced in Europe back in the 4th century. Since the 19th century, this technique has been rapidly expanding around the world, particularly in the Copyright © 2020, Journal of Archives in Military Medicine. ...
Background: Patellofemoral Pain Syndrome (PFPS) is one of the most common diagnoses made for patients referred to physical/rehabilitation and orthopedic clinics. The most common symptom of PFPS is a diffuse pain in front of either one or both knees exacerbated by intense activity, kneeling, squatting, climbing, and weakness of quadriceps muscle. Lumbosacral manipulation and knee exercises are the most commonly used methods in physical medicine with no major side effects. Objectives: The current study aimed to compare the efficacy of the lumbosacral manipulation technique with knee exercises versus sole knee exercises in patients with PFPS. Study Design was Randomized Controlled Clinical Trial. Methods: In this randomized controlled clinical trial, 30 patients (18 females and 12 males) diagnosed with PFPS were divided into two groups of study and control, each with 15 subjects. Those in the intervention group received a single bilateral lumbosacral manipulation after ruling out any contraindication for lumbosacral manipulation by lumbosacral radiography. Quality of life, gait, quadriceps muscle strength, keen pain improvement, and range of motion were evaluated at the beginning and four weeks following the knee strengthening exercises for all participants. Results: The mean age of participants was 34 ± 5 years. The difference between the groups concerning the swing phase of walking and quadriceps muscle strength was in both groups was investigated following providing interventions. Conclusions: The manipulation technique had a greater effect on improving the function of patients with PFPS compared to therapeutic knee exercises.
... 10 This is also supported by recent case reports, detailing the utilization of thrust and non-thrust joint mobilization in the management of chronic anterior knee pain, knee extensor deficits, and self-reported disability despite previous bouts of exercise-based physical therapy, although further investigation would be useful. 32,33 A number of limitations exist related to this systematic review. This review limited included papers to those published in English, which may have excluded relevant works. ...
Objective:
To investigate and synthesize the effects of joint mobilization on individuals with patellofemoral pain syndrome.
Data sources:
Five electronic databases (CINAHL, the Cochrane Central Register of Controlled Trials, PubMed, Scopus, and SPORTDiscus) were used.
Review methods:
Each database was searched from inception to 1 November 2017. Randomized controlled trials investigating a manual therapy intervention, with or without co-interventions, for persons with patellofemoral pain were included. Two reviewers independently screened the retrieved literature and appraised the quality of the selected studies using the PEDro rating scale. A third reviewer was used in cases of discrepancy to create a consensus.
Results:
A total of 361 articles were identified in the search. Twelve randomized trials with a total of 499 participants were selected for full review. Within-group improvements in pain and function were noted for the manual therapy groups. Between-group improvements for short-term outcomes (three months or less) were greatest when joint mobilization was directed to the knee complex and used as part of a comprehensive approach.
Conclusion:
In the articles reviewed, joint mobilization appears to be most effective in improving pain and function when coupled with other interventions, although its discrete effect is unclear due to the reviewed studies’ design and reporting.
Keywords: knee, manipulation, manual therapy, pain, patellofemoral
... Biomechanically, limited ankle DF during gait has been associated with excessive STJ pronation. [54][55][56] and are likely explained by a combination of peripheral and central mechanisms. ...
Background & purpose:
Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise.
Case description:
A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms.
Outcomes:
The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up.
Discussion:
Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function.
Level of evidence:
Therapy, Level 4.
... 26 There is also conflicting evidence as to whether lumbar manipulation is beneficial in increasing knee extensor strength and force output. [27][28][29] PFPS is assumed to be multifactorial in nature; it is necessary to thoroughly examine and broadly hypothesize potential contributing factors and structures for successful management. To the authors' knowledge, only one study has ever researched the effects of joint mobilization directed at the tibiofemoral joint in this subject population; the study's main focus being normalization of biomechanics and movement patterns. ...
Background and purpose:
Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. Controversy exists over the exact clinical findings which define PFPS, thus, diagnosis and management can be challenging for clinicians. There is paucity in the literature concerning joint mobilization as treatment for PFPS, particularly at the tibiofemoral joint, as standard management is currently focused on therapeutic exercise, orthotics, bracing and taping. Therefore, the purpose of this case report is to describe the effects of tibiofemoral joint mobilization in the successful treatment of an individual with chronic PFPS as it relates to pain, function and central processing of pain.
Study design:
Case Report.
Case description:
The subject was a 28-year-old female with a two year history of left anterior, inferior patellar knee pain consistent with chronic PFPS. She demonstrated diminished pressure pain threshold (PPT) and allodynia at the anterior knee, suggesting a component of central sensitization to her pain. She met several common diagnostic criteria for PFPS, however, only tibiofemoral anterior-posterior joint mobilization increased her pain. Subsequent treatment sessions (Visits 1-6) consisted of solely joint mobilization supplemented by instruction in a home exercise program (therapeutic exercise and balance training). As outcomes improved, treatment sessions (Visits 7-8) consisted of solely therapeutic exercise and balance training with focus on return to independent pain free functional activity.
Outcomes:
Improvements consistent with the minimally clinically important difference were noted on the Kujala Anterior Knee Pain Scale, Numeric Pain Rating Scale, Global Rating of Change (GROC). Scores on the Fear Avoidance-Belief Questionnaire (6/24 to 2/24 PA, 31/42 to 5/42 W), PPT (119 to 386 kPa) and Step Down Test (11 to 40 steps) also demonstrated improvement. At a two month follow up, the subject reported continued improvement in functional activity, 0/10 pain and GROC = +5.
Discussion:
This case describes the successful use of tibiofemoral joint mobilization in a subject with chronic PFPS and supports the use of joint mobilization as management in PFPS, particularly in cases where a centrally mediated component of pain may be present.
Level of evidence:
Therapy, Level 5.
