Knee joint mobilization

Comprehensive Guide to Knee Joint Mobilizations

Knee joint mobilizations are manual therapy techniques employed to alleviate pain, enhance range of motion, and address joint dysfunctions. These interventions involve the application of oscillatory manual forces to the tibiofemoral, proximal tibiofibular, or patellofemoral joints. The direction, position, and hand placement for these mobilizations are tailored to the patient’s specific condition and therapeutic objectives.

Classification of Mobilization Grades: Maitland’s System

Mobilizations are categorized into four grades based on the amplitude of movement and the level of resistance encountered:

Grade I

Amplitude: Small
Oscillations: Slow, at the beginning of the joint’s range of motion
Purpose: Primarily aimed at pain modulation with light pressure

Grade II

Amplitude: Large
Oscillations: Slow, within the entire available range of motion
Purpose: Pain modulation without reaching joint resistance

Grade III

Amplitude: Large
Oscillations: Slow, applied from mid to end-range of motion
Purpose: Increase range of motion and reduce stiffness

Grade IV

Amplitude: Small
Oscillations: Slow, at the end-range of motion
Purpose: Increase joint mobility and reduce stiffness

Grades I and II focus on pain relief, while Grades III and IV are employed to address mobility issues and stiffness.

Indications for Knee Mobilizations

Knee joint mobilizations are beneficial for various conditions, including:

Post-operative Rehabilitation: Assisting in recovery following knee surgeries.
Knee Osteoarthritis (OA): Managing symptoms and improving function.
Pain, Stiffness, and Joint Hypomobility: Addressing discomfort and limited movement.
Patellofemoral Pain Syndrome (PFPS): Alleviating pain and enhancing knee function.

Evidence of Effectiveness in Knee OA

Deyle et al., 2000:
- Study Design: Compared manual therapy and exercise with placebo ultrasound in 83 patients.
- Findings: Significant improvements in pain and function, maintained at one-year follow-up.
Deyle et al., 2005:
- Study Design: Compared manual therapy and exercise with a home exercise program in 134 patients.
- Findings: Both groups improved, but the manual therapy group showed higher satisfaction and reduced medication usage after one year.
Systematic Review (Weleslassie et al., 2020):
- Study Design: Analyzed 15 RCTs with 704 participants.
- Findings: Demonstrated significant pain reduction and functional improvement in most studies.

Evidence of Effectiveness in PFPS

Randomized Study on 50 Patients:
- Intervention: Combined patellar mobilization and taping with conventional therapy.
- Findings: Significant pain reduction and improved knee function after 12 sessions.
Additional Studies:
- Findings: Suggest joint mobilizations may reduce aberrant pain mechanisms and enhance biomechanics, making them an effective adjunct to PFPS management.

Contraindications

Mobilizations should be avoided in the following situations:

Unhealed fractures near the joint
Joint replacement (arthroplasty)
Acute inflammatory or septic arthritis
Bone infections (osteomyelitis)
Malignancy or neoplastic disease
Physiologically unstable joints

Techniques of Knee Mobilization

Tibiofemoral Joint

Resting Position: 25° knee flexion
Treatment Plane: Along the tibial plateau
Stabilization: Femur stabilized

Distraction

Indication: Pain control, general mobility
Position:
1. Prone Lying: Patient lies face down; thigh stabilized with a belt.
2. Supine Lying: Patient lies on back; distraction applied along the tibia.
3. Sitting Position: Leg hangs off the table.
Force Application: Therapist grips just above the malleoli and leans backward to create a distraction force.

Anterior Glide

Indication: Increase knee extension
Position:
- Crook lying or prone lying with the knee supported.
Force Application: Force applied on the posterior tibia to produce anterior motion.

Posterior Glide

Indication: Increase knee flexion
Position: Supine lying with knee slightly flexed, supported under the distal femur.
Force Application: Force applied perpendicular to the tibia in the posterior direction.

Patellofemoral Joint

The patella glides proximally during knee extension and distally during flexion.

Patellar Glides

Indication: Increase patellar mobility
Position: Supine with knee slightly flexed
Force Application:
- Medial glide: Press on the lateral patella.
- Lateral glide: Press on the medial patella.
- Superior glide: Mobilize the patella upward.
- Inferior glide: Mobilize the patella downward.

Rotational Glides

Indication:
- Internal rotation: Increases knee flexion.
- External rotation: Increases knee extension.
Position: Supine with knee flexed.
Force Application: Stabilize the distal femur while applying rotational motion through the foot.

Knee mobilizations are powerful techniques to restore function and alleviate pain. They should be applied judiciously and tailored to the patient’s condition, goals, and physical presentation.

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For a visual demonstration of knee mobilization techniques, you may find the following video helpful: