Knee Joint Play Testing & Mobilization

superior-inferior glide of the patella

-assess joint play motion at *patellofemoral joint* and improves motion at knee necessary for *knee extension or flexion* -pt supine with knee supported on towel roll at about 3-5 degrees of flexion -distract patella then glide -superior, inferior -keep arm in line with tibia (line of force)

anterior glide of tibiofemoral joint (supine)

-assesses anterior joint play at knee and to improve motion at *tibiofemoral joint necessary for knee extension* -terminal knee extension important -pt supine with knee flexed (hooklying) -PT sits on pt foot -stabilizing hand grasps *distal aspect of femur* -mobilizing hand secures *posterior aspect of tibia while thumb palpates joint line* -with lumbrical grip, apply *anterior force* -can use both hands to apply PA force -can place wedge under foot if lacking DF -to *mobilize*: can inc or dec amount of knee extension -line of pull stays in same plane as tibial plateau

anterior glide of tibiofemoral joint (sitting)

-assesses anterior joint play motion at the knee, improves motion at *tibiofemoral joint necessary for knee extension* -pt sits edge of table, knee flexed to 90 -pt's tibia secured between PTs knees -PT grasps posterior aspect of tibia, palpate joint line with thumbs -can use *mobilization belt* to secure pt and distract (wrap around ankle few times then PT foot through bottom, securd on floor) -*mobilization*

anterior glide of tibiofemoral joint (prone)

-assesses anterior joint play motionat knee, to improve motion at *tibiofemoral joint necessary for knee extension* -pt prone with pillow under hips, towel under femur -knee flexed 10-25 degrees -stabilizing hand grasps distal aspect of tib/fib (hold at pt ankle) -operating hand secures posterior surface of proximal aspect of tibia -using lumbrical grip (on medial aspect of lower leg, move medial tissue out of way), an *anterior force is exerted via the mobilizing hand* -varying degrees of knee flexion used -can used to *assess & mobilize*

anterior glide of medial condyle (prone)

-assesses anterior joint play of *medial tibial condyle at knee* and to improve component motion at tibiofemoral joint necessary for *terminal knee extension* (screw home mechanism) -anteromedial -pt prone with knee flexed 10 degrees, can progress into extension end range -wedge, towel under distal femur -stabilizing hand grasps at ankle -operating hand secures posterior surface of proximal aspect of medial tibia -*anterior force* introduced with *counterbalance force* (PA force with slight lateral) -mobilization belt can be used to secure femur -as further into extension, put tibia into ER

anterior/lateral and posterior/medial glide of proximal tibiofibular joint

-assesses joint play motion at *proximal tibiofibular joint* and to improve motion at the proximal tibiofemoral joint necessary for *ankle plantar flexion and dorsiflexion* -pt supine with knee flexed to 80-90 deg -PT sit on pt foot -stabilize distal aspect of femur -operating hand secures posterior surface of fibular head -operating hand introduces *anterolateral force through finger contacts* -*posteromedial force* may be introduced via thumb contact (can also use hypothenar eminence) -be aware of nerve bundle

superior glide of the proximal tibiiofibular joint

-assesses joint play motion at proximal tibiofibular joint and to improve component motion at proximal tibiofibular joint necessary for *ankle dorsiflexion & eversion* -pt supine with knee extended -stabilize proximal tibia, fingers palpate fibular head and joint line -operating hand secures lateral, plantar surface of calcaneus -*superior force through heel of hand* -*maintain calcaneal eversion* -contralateral hand *monitors fibular head motion* -can assess -good for *mobilization*

medio-lateral glide of the patella

-assesses mediolateral joint play motion at patellofemoral joint and to improve motion necessary for *knee flexion and extension* -pt supine with knee supported on towel roll at about 3-5 degrees of flexion -distract patella then glide -medial, lateral -*mobilization* grades I - III

posterior glide of lateral condyle (supine)

-assesses posterior joint play motion of *lateral tibial condyle at the knee* and improves component motion at *tibiofemoral joint necessary for knee extension* -pt supien with knee flexed or same position as anterior glide -may progress into extension end range -stabilizing hand grasps distal aspect of femur -operating hand secures anterior surface of proximal, lateral tibia -*posterior force* through lateral tibial condyle -to *mobilize*: add in more flexion to progress -inc'd knee flexion (>120) --> PT *radially deviates* hands THEN mobilize