Maddie Pedlar

Manual Therapy for the Hip, Knee, and Lower Leg Complex
Clinical Application Worksheet

Course Objectives Covered: 2, 3, 5, 9, 12, 13.

Associated CAPTE Standards:
- 7D20: Evaluate data from the examination to make clinical judgments.
- 7D27: Competently perform physical therapy interventions to achieve patient/client goals and outcomes.
- 7D30: Monitor and adjust the POC in response to patient/client status.

Instructions:
 Impairment/limitation is provided.
 Select 3 varying manual interventions (mobs, STM, stretching, MWM, PNF, etc.) that would be most
appropriate to address the impairment or functional limitation.
o Prescribe manual interventions not only from this course but also techniques learned in PTH646 or during
your clinical experience.
o Must provide a VARIETY of techniques/ideologies (Don’t use all Maitland mobs in one impairment)
 Provide intent and details/dosage for chosen techniques.
o Intent = to create change within a particular structure (joint capsule, connective tissue, soft tissue, neural
tissues) that will contribute to reducing/eliminating the dysfunction/impairment. (e.g. applying a sustained
inferior glide to the GH joint during active shoulder abduction allows for improved clearance of greater
tuberosity under acromion.)
o Details/Dosage = rate/rhythm, amplitude, relationship to barrier, frequency/duration, reps/sets as it relates to
the general purpose (e.g. joint decompression, reduce pain, improve mobility) and based on the
methodology/school of thought (e.g.. Maitland, Kaltenborn, Mulligan, etc.). Link the joint mobilization
grading descriptions to this.
 Practice hands-on techniques with your partner.
 Scoring: .25 pts. per item (technique = .25, intent for technique = .25, dosage/details = .25, multiplied x 3 for
each impairment/limitation).

Hip
1. Decreased FABER
Technique Intent
1. SCS: Hamstrings By applying a SCS to the
lateral hamstrings, this will
allow for the muscle tissue to
gain extensibility. Placing the
muscle in its most shortened
position and finding a POC
before applying a sustained
hold will aid in reducing the
restrictions around the joint.
With increased muscle tissue
extensibility of the lateral
hamstrings, there will be
improved flexion and ER
ROM.
2. Isometric MET: The hip internal rotators will
Hip ER be utilizing an autogenic
Limitations inhibition technique to
(antagonist = hip improve hip ER ROM. The
internal rotators) hip will progress towards a
new barrier for hip ER, while
the hip internal rotators will
be working against resistance
Dosage/Details
Pt position: Prone
PT position: Standing on involved side; find TP (proximal to knee
joint) on lateral hamstrings (BF)
Action: Maintain contact over TP, flex knee to 100o and apply
tibial ER w/2-5 lb. overpressure to target BF. Find the POC
Dosage: Hold position for 90 seconds. Reposition as needed and
repeat 2-3 times if necessary or until there is a change in
symptoms/release of TP.
Pt position: Prone
PT position: Standing on involved side, flex involved knee to 90o
and place pt. to their end-range barrier into ER.
Action: Apply light-moderate pressure at the end-range barrier
into hip ER while the patient performs an isometric contraction to
resist (pushing into hip IR), working the hip internal rotators.

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(performing an isometric
contraction). Activating the
hip internal rotators will
inhibit the external rotators,
allowing the hip to go into
greater ER ROM since there
will be increased flexibility
and extensibility of the hip
internal rotators.
3. Hip Traction By applying a sustained
(Distal Glide) traction of the proximal
(Kaltenborn femur from the acetabulum,
Grade III) this will allow for greater
mobility in the hip by
increasing space in the joint
capsule. Moving past the TZ
range into a stretch zone will
allow for a stretch to be
placed on the joint capsule
and surrounding tissues,
increasing muscle tissue
extensibility in the hip joint,
and improving mobility.
2. Lateral hip pain (bursa maybe)
Technique Intent
1. Hip Oscillatory By applying low grade large
Release (Maitland rhythmic oscillations to the
Grade II) LE, this will increase tissue
extensibility and create space
in the joint capsule. This will
allow for a greater stretch
throughout the LE and less
tension on the lateral hip,
which should decrease the
pain.
2. Lateral Apply a sustained lateral
Traction/Lateral glide of the proximal femur
Glide (Kaltenborn on the acetabulum. Once pain
Grade II) relief is stated, moving into
the TZ will allow for greater
extensibility of the tissues
and take up the slack of the
joint capsule. This will assist
in allowing for improved
pain-free hip mobility.
3. Direct STM to By applying a direct pressure
Hip Internal on the tender point of the hip
Maddie Pedlar
Dosage: Hold the isometric contraction for 3-5 seconds. Reassess
hip ER AROM and move into the new barrier after each rep.
Perform this technique for 3-5 reps.
Pt position: Supine w/distal thigh resting on small bolster. Hip in
its OPP (30o Flex, 30o ABD, slight ER). Ask pt. to hold on to table
for more stabilization.
PT position: Standing at the EOB, hold distal lower leg OR hold
above the knee.
Action: Shift body weight back, arms fully extended. Apply
sustained traction of the proximal femur moving away from the
acetabulum.
Dosage: Kaltenborn Grade III: stretching, moving past the TZ
range into stretch zone. Hold for 7 seconds and repeat for 10 reps
total. After ~5 reps are performed, assess hip FABER ROM, and
then perform another 7 second sustained hold with 5 more reps,
followed by another reassessment of hip FABER ROM.
Dosage/Details
Pt position: Supine; Hip in IR or in its OPP (30o Flex, 30o ABD,
slight ER).
PT position: Standing at the EOB, w/pt.’s hip in IR or OPP, lean
back and initiate rhythmic oscillations (R/L, flex/ext).
Action: Apply rhythmic oscillatory motions (2-3 oscillations per
second) to the R/L, possibly w/some flex/ext to the involved LE.
Modify force/intensity based on pt. response or improved
mobility.
Dosage: Maitland Grade II: large amplitude, stopping short of R1;
perform oscillations for 30 seconds, 1-2 sets, and 1-5 reps.
Pt position: Supine w/hip in its OPP (30o Flex, 30o ABD, slight
ER). An additional belt can be used to stabilize pelvis.
PT position: Standing on involved side, wrap a mobilization belt
around pt.’s proximal involved thigh. Stabilize at the ipsilateral
iliac crest and knee w/your hands.
Action: Apply a sustained lateral glide of femur on the
acetabulum.
Dosage: Kaltenborn Grade II: distraction (tightening), moving
w/in the SZ range (and TZ when pain is relieved); perform
sustained hold for 3-5 seconds and repeat for 10 reps total. After
~5 reps are performed, assess pain w/PROM of the hip, and then
perform another 3-5 second sustained hold with 5 more reps,
followed by another reassessment of pain w/PROM of the hip.
Pt position: Prone
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Rotators: Pin and internal rotators, this will
Stretch allow for the tense tissue to
break up and have greater
extensibility. Slowly moving
the hip into the barrier (ER)
will allow the muscle tissue
to lengthen and create more
flexibility and less tension in
the surrounding muscle
tissues.
3. Limitations Internal and External Rotation
Technique Intent
1. Direct STM to By applying a direct pressure
Hip Rotators: Pin on the tender point of the hip
and Stretch internal/external rotators, this
will allow for the tense tissue
to break up and have greater
extensibility. Slowly moving
the hip into the barrier
(ER/IR) will allow the
muscle tissue to lengthen and
create more flexibility and
less tension in the
surrounding muscle tissues.
2. Isometric MET: The hip external rotators will
Hip IR be utilizing an autogenic
Limitations inhibition technique to
(antagonist = hip improve hip IR ROM. The
external rotators) hip will progress towards a
new barrier for hip IR, while
the hip external rotators will
be working against resistance
(performing an isometric
contraction). Activating the
hip external rotators will
inhibit the internal rotators,
allowing the hip to go into
greater IR ROM since there
will be increased flexibility
and extensibility of the hip
external rotators.
3. AP Trochanteric By applying large oscillatory
Mobilization for motions with an anterior
Hip ER (Maitland glide of the greater
Grade III) trochanter, this will increase
tissue extensibility and create
space in the joint capsule.
This will allow for improved
hip ER ROM.
Maddie Pedlar
PT position: Standing on involved side, flex pt.’s knee to 90o.
With the other hand, use finger pads to sink down into the tender
internal rotator muscle tissues.
Action: One hand applies direct pressure (pin down) to the tender
point of the IR muscle bellies and the other hand lengthens the
tissue towards the barrier by moving the hip into ER.
Dosage: Hold direct pressure while slowly moving into the
barrier/pt. comfort for 8-15 reps and reassess tissue quality.
Dosage/Details
Pt position: Prone
PT position: Standing on involved side, flex pt.’s knee to 90o.
With the other hand, use finger pads to sink down into the tender
internal/external rotator muscle tissues.
Action:
Improving ER: One hand applies direct pressure (pin down) to
the tender point of the IR muscle bellies and the other hand
lengthens the tissue towards the barrier by moving the hip into
ER.
Improving IR: One hand applies direct pressure (pin down) to
the tender point of the ER muscle bellies and the other hand
lengthens the tissue towards the barrier by moving the hip into IR.
Dosage: Hold direct pressure while slowly moving into the
barrier/pt. comfort for 8-15 reps and reassess tissue quality.
Pt position: Prone
PT position: Standing on involved side, flex involved knee to 90o
and place pt. to their end-range barrier into IR.
Action: Apply light-moderate pressure at the end-range barrier
into hip IR while the patient performs an isometric contraction to
resist (pushing into hip ER), working the hip external rotators.
Dosage: Hold the isometric contraction for 3-5 seconds. Reassess
hip IR AROM and move into the new barrier after each rep.
Perform this technique for 3-5 reps.
Pt position: Supine
PT position: Standing at EOB, stabilize contralateral ASIS w/one
hand. Hook thenar eminence on anterior surface of greater
trochanter w/the other hand.
Action: Apply an oscillatory (2-3 oscillations per second) AP
glide of the greater trochanter.
Dosage: Maitland Grade III: large amplitude, taken to 50% R1-R2
(into the barrier); perform AP glide oscillations for 30 seconds, 1-
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4. Limited hip extension/ hip flexor-anterior stiffness
Technique Intent
1. SCS: Iliacus By applying a SCS to the
iliacus, this will allow for
the muscle tissue to gain
extensibility. Placing the
muscle in its most shortened TP.
position and finding a POC
before applying a sustained
hold will aid in reducing the bring B knees toward side of TP. Find pain-free POC.
restrictions around the joint.
With increased muscle
tissue extensibility of the
iliacus, there will be
improved hip extension and
reduced hip flexor stiffness.
2. Ventral (Anterior) By applying large
Glide (Maitland oscillatory motions with an
Grade III) anterior glide of the
proximal femur on the
acetabulum, this will
increase tissue extensibility
and create space in the joint Action: Keep the mobilizing elbow straight, using full body
capsule. This will allow for
improved hip extension
ROM and reduced hip
flexor stiffness.
3. MWM: Lateral Providing a laterally-
Glide + Hip Ext directed force on the
proximal femur allows for a
pain-free improved ROM
during hip extension since
they are working together to Place hands on pt.’s ipsilateral iliac crest for a
reposition the joint back to
its anatomical position.
With this, prior hip function Action: Have the patient actively lunge forward (performing hip
should be restored with no
pain.
5. Buttock Pain –hmmm?🤔
Technique Intent
1. SCS: Piriformis By applying a SCS to the
piriformis, this will allow for
the muscle tissue to gain
extensibility. Placing the
muscle in its most shortened
position and finding a POC
Maddie Pedlar
2 sets, and 1-5 reps.
Dosage/Details
Pt position: Supine, hips flexed to 100o, knees flexed to 130o.
Ankles crossed to ER the hips.
PT position: Standing on involved side, palpate the iliacus for a
Action: Maintain contact over TP. Maintain pt.’s hip ER and
Dosage: Hold position for 90 seconds then reassess hip extension.
Reposition as needed and repeat 2-3 times if necessary.
Pt position: Prone w/small towel under abdomen around ASIS.
PT position: Standing on involved side, cup patella to control the
distal leg w/caudal hand. Place the other hand on the proximal
femur to provide mobilizing force.
rocking/squatting to provide the anterior mobilization. Apply an
oscillatory (2-3 oscillations per second) anterior glide of the
proximal femur on the acetabulum.
Dosage: Maitland Grade III: large amplitude, taken to 50% R1-R2
(into the barrier); perform anterior glide oscillations for 30
seconds, 1-2 sets, and 1-5 reps.
Pt position: Standing w/uninvolved leg on chair (hip flexed to 90o
and knee flexed to 90o) w/one hand holding onto chair for support.
PT position: Standing on involved side, place mobilization belt
around pt.’s proximal thigh and beneath your ischial tuberosities.
stabilization/counteracting force.
flex/ext) on the chair. During the movement, apply a laterally-
directed force w/the belt on the proximal femur and a
counteracting/stabilizing medially directed-force on the ipsilateral
iliac crest.
Dosage: After the patient reports pain-free movement with the
stabilization, have the patient actively move through hip
flexion/extension for 5-10 reps while applying the stabilizing
force.
Dosage/Details
Pt position: Prone, involved LE off EOB. Hip flexed to 120o and
knee flexed to 90o.
PT position: Standing on involved side, hold the involved LE at
the distal leg/knee w/one hand and palpate the piriformis for a TP
w/the other hand.
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before applying a sustained
hold will aid in reducing the
restrictions around the joint.
With increased muscle tissue
extensibility of the
piriformis, there will be
improved hip mobility with
decreased buttock pain.
2. Hip Oscillatory Refer to question 2.1
Release (Maitland
Grade II)
3. MWM: Lateral Providing a laterally-directed
Glide + Hip ER force on the proximal femur
allows for a pain-free
improved ROM during hip
ER since they are working
together to reposition the
joint back to its anatomical
position. With this, prior hip
function should be restored
with no pain.
Knee and Lower Leg
1. Limited knee extension
Technique Intent
1. STM: Transverse By applying a transverse MFR
MFR to to the hamstrings muscle tissue
Hamstrings (direct force), this will allow
for greater extensibility and
stretch to the posterior fascial
chain. Starting more
superficial/light will relax the
hamstrings, followed by a more
direct force into the barrier. The
relaxed hamstrings will allow
for the knee to have greater
mobility in extension since
there is less tension on the
muscle. This will improve knee
extension ROM.
2. Anterior Tibial By applying large oscillatory
Glide of tibia on motions with an anterior glide
femur (Maitland of the proximal tibia on the
Grade III) distal femur, this will increase
tissue extensibility and create
space in the joint capsule. This
will allow for improved knee
extension ROM.
Maddie Pedlar
Action: Maintain contact over TP (mid-belly). Apply 20o ER and
10o ABD, moving slowly in one direction at a time. Find POC.
Dosage: Hold position for 90 seconds then reassess pain w/hip
mobility. Reposition as needed and repeat 2-3 times if necessary.
Refer to question 2.1
Pt position: Standing
PT position: Standing on involved side, place mobilization belt
around pt.’s proximal thigh and beneath your ischial tuberosities.
Place hands on pt.’s ipsilateral iliac crest for a
stabilization/counteracting force.
Action: Have the patient actively ER the uninvolved LE (pivot
away from the PT). During the movement, apply a laterally-
directed force w/the belt on the proximal femur and a stabilizing
medially force on the ipsilateral iliac crest.
Dosage: After the patient reports pain-free movement with the
stabilization, have the patient actively move through hip ER for 5-
10 reps while applying the stabilizing force.
Dosage/Details
Pt position: Prone w/legs fully extended
PT position: Standing on involved side
Action: Stabilize hamstring tissue distally w/one hand and the other
hand applies a M-L or L-M pressure w/palmar surface of hands. Find
the barrier and move into it, starting more superficial/light until a
release is achieved.
Dosage: Hold position for 3-5 minutes after release then reassess knee
extension ROM.
Pt position: Prone w/lower leg off EOB. Knee needs to be in OPP
(slight flexion).
PT position: Standing at EOB on involved side, supporting the
proximal and distal tibia. Pt.’s thigh is stabilized against the table.
Action: Apply an oscillatory (2-3 oscillations per second) anterior glide
of the proximal tibia on the distal femur.
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3. MWM: NWB Providing a counteracting
Flexion and stabilizing force on the distal
Extension (supine) femur and proximal tibia allows
for a pain-free improved ROM
during knee extension/flexion
since they are working together
to reposition the joint back to
its anatomical position. With
this, prior knee function should
be restored with no pain.
2. Limited knee flexion
Technique Intent
1. MET: Knee The quads will be utilizing an
Flexion Isometric autogenic inhibition technique
Contraction to improve knee flexion ROM.
(antagonist = The knee will progress towards
quads) a new barrier for knee flexion
while the quads will be working
against resistance (performing
an isometric contraction).
Activating the quad muscles
will inhibit the hamstrings,
allowing the knee to go into
greater flexion ROM since
there will be increased
flexibility and extensibility of
the quadriceps.
2. Posterior Tibial By applying a sustained
Glide of tibia on posterior glide of the proximal
femur (Kaltenborn tibia on the distal femur, this
Grade III) will allow for greater mobility
in the knee by increasing space
in the joint capsule. Moving
past the TZ range into R2 will
allow for a stretch to be placed
on the joint capsule and
surrounding tissues, increasing
muscle tissue extensibility in
the tibiofemoral joint and
improving knee flexion ROM.
3. MWM: NWB Refer to question 1.3
Flexion and
Extension
3. Patellofemoral restrictions
Technique Intent
1. Patellofemoral By applying small oscillatory
Maddie Pedlar
Dosage: Maitland Grade III: large amplitude, taken to 50% R1-R2
(into the barrier); perform anterior glide oscillations for 30 seconds, 1-
2 sets, and 1-5 reps.
Pt position: Supine w/legs fully extended and towel or bolster beneath
calf
PT position: Standing on involved side, place one hand on the distal
lateral femur and the other on the proximal tibia.
Action: Have the patient actively flex/extend their knee (perform heel
slides). Apply a medially-directed force on the distal femur and a
laterally-directed force on the proximal tibia.
Dosage: After the patient reports pain-free movement with the
stabilization, have the patient actively move through knee
flexion/extension for 5-10 reps while applying the stabilizing force.
Dosage/Details
Pt position: Prone (or supine if pt. can’t go into prone) with knee into
full end-range flexion (pain-free)
PT position: Standing at the EOB facing the pt.
Action: Apply light-moderate pressure at the end-range barrier into
knee flexion while the patient performs an isometric contraction to
resist (pushing into knee extension), working the quads.
Dosage: Hold the isometric contraction for 3-5 seconds. Reassess
knee flexion AROM and move into the new barrier after each rep.
Perform this technique for 3-5 reps.
Pt position: Supine or seated w/full leg resting on table w/a bolster
beneath the distal femur.
PT position: Standing on the opposite side of involved knee, the
bolster stabilizes the femur. Stabilize the anterior distal femur w/one
hand while the moving hand is placed on the proximal tibia (tibial
plateaus/tubercles).
Action: Apply sustained posterior glide of the proximal tibia on the
distal femur.
Dosage: Kaltenborn Grade III: stretching, moving past the TZ range
into R2. Hold for 7 seconds and repeat for 10 reps total. After ~5 reps
are performed, assess knee flexion ROM, and then perform another 7
second sustained hold with 5 more reps, followed by another
reassessment of knee flexion ROM.
Refer to question 1.3
Dosage/Details
Pt position: Supine with knee in its OPP (full extension).
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Inferior/Distal motions with an inferior/distal
Glide of patella on glide of the patella on the distal
the distal femur femur, it will allow for the
(Maitland Grade quadriceps tendon to have less
IV) tension and increased
extensibility. Prior to the
inferior/distal glide, perform a
slight traction force to distract
the patella from the distal
femur. With the increase of
tissue extensibility of the quad
tendon, the patella will be able
to freely move with increased
mobility during knee
movements.
2. Patellofemoral Jt. Providing an oscillatory force
Mob on the proximal patellar border
(Inferior/Distal while moving the knee into
Glide Maitland flexion/extension allows for a
Grade IV) + pain-free improved ROM since
Passive Release they are working together to
reposition the patella back to its
anatomical position. With this,
prior knee function should be
restored with no pain.
3. MET: Knee Refer to question 2.1
Flexion Isometric
Contraction
(antagonist =
quads)
Maddie Pedlar
PT position: Standing on involved side, stabilize distal femur or use
table to stabilize (depending on amount of knee flexion); w/the other
hand, grip patella w/heel of your hand, placing forearm parallel to
and next to the distal thigh.
Action: Apply sight traction, followed by an oscillatory (2-3
oscillations per second) inferior/distal glide of the patella on the
distal femur.
Dosage: Traction: Grade Maitland Grade I: small amplitude,
stopping short of R1; perform traction force (picking up and moving
patella away from distal femur) for 15-30 seconds, 1 rep.
Oscillatory Glide: Maitland Grade IV: small amplitude, taken into
and through 50% R1-R2; perform inferior/distal glide oscillations for
30 seconds, 1-2 sets, and 1-5 reps.
Pt position: Supine with knee in its OPP (full extension).
PT position: Standing on involved side, apply a “pin” to the proximal
patellar border. The moving hand is placed on the distal tibia.
Action: Apply oscillatory (2-3 oscillations per second) inferior/distal
glide of the patella on the distal femur while the mobilizing hand
moves the tibia into knee flexion and extension.
Dosage: Maitland Grade IV: small amplitude, taken into and through
50% R1-R2; perform inferior/distal glide oscillations for 30 seconds,
1-2 sets, and 1-5 reps.
Refer to question 2.1

4. Lateral knee pain and ankle dysfunctions

Technique Intent Dosage/Details

1. Proximal By applying large
Tibiofibular oscillatory posterior glides
Posterior Glide of the fibular head on the
of the fibular proximal tibia, this will
head on the provide pain relief with
proximal tibia knee/ankle movement.
(Maitland Providing oscillations of
Grade II) the fibular head moving
posteriorly on the proximal
tibia will allow for
improved pain-free
knee/ankle mobility and
increased space in the joint
capsule.
2. Proximal HVLAT addresses multiple
Tibiofibular planes of motion and will
Joint allow for improved
Manipulation mobility in the knee/ankle.
for an Anterior Focusing on mobilizing the
Fibular Head fibular head
(HVLAT) posteromedially will allow
for improved pain-free
Pt position: Supine w/LE in OPP (knee semi-flexion, ankle semi-
plantarflexion).
PT position: Sitting on the EOB, sit on involved foot to stabilize. Fixate the
proximal tibia w/one hand and grasp around fibular head w/the other hand.
Action: Apply an oscillatory posteromedial force (2-3 oscillations per
second) through the fibular head on the proximal tibia.
Dosage: Maitland Grade II: large amplitude, stopping short of R1; perform
oscillations for 30 seconds, 1-2 sets, and 1-5 reps.
Pt position: Supine w/LE in OPP (knee semi-flexion, ankle semi-
plantarflexion).
PT position: Standing at the EOB facing the pt.; place thenar eminence on
the anterior fibular head. Place the other hand on the distal tibia to stabilize.
Action: Push fibular head posteromedially as you perform tibial IR w/the
other hand. Find R2 w/Maitland Grade IV mobilizations (small oscillations

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knee/ankle mobility. This
will allow for the fibular
head to properly be placed
back into the proximal
tibiofibular joint capsule
and correctly articulate
with the proximal tibia.
3. Anterior Tibial Apply a sustained anterior
Glide w/Focus glide of the proximal tibia
on Medial on the distal femur with a
Compartment focus on the medial
(Kaltenborn compartment of tibia. If the
Grade II) pain intensifies due to the
tightening of collateral
ligaments, focus on
mobilizing the lateral
compartment to tighten the
cruciate ligaments. Once
pain relief is stated,
moving into the TZ will
allow for greater
extensibility of the tissues
and take up the slack of the
joint capsule. This will
assist in allowing for
improved pain-free
knee/ankle mobility.
5. Medial tibiofemoral joint line pain and hypomobility
Technique Intent
1. Meniscal Providing a lateral-
Mobilization posteriorly directed
(Option 2) force/compression to the
medial meniscus while
stabilizing the distal tibia
will allow for a
pain-free/improved ROM
during knee movement.
The direct pressure will
loosen up the tissue and
improve motion of the
meniscus during knee
movements.
2. MWM: Providing a posteriorly
Meniscal directed force (squeeze) to
“Squeeze” the medial meniscus while
stabilizing around the knee
and distal femur will allow
for a pain-free/improved
ROM during knee
movement since they are
working together to
reposition the meniscus
back to its anatomical
position. The pt. will feel
uncomfortable during the
mobilization but should
feel relief after.
Maddie Pedlar
(2-3 oscillations per second) to the barrier) and apply HVLAT
posteromedially on the fibular head beyond R2.
Dosage: Maitland Grade V: small amplitude, high velocity at R2 and
beyond; once the barrier is reached, apply a high-velocity low amplitude
thrust through the barrier. Perform once and reassess knee/ankle mobility
and pain.
Pt position: Prone w/lower leg off EOB. Knee needs to be in OPP (slight
flexion).
PT position: Standing at EOB on involved side, supporting the proximal and
distal tibia. Pt.’s thigh is stabilized against the table. Grip the medial side of
the tibia w/the moving hand (or lateral if pain is too intensive).
Action: Medially rotate the tibia w/proximal and distal hands. Apply a
sustained anterior glide of the tibia moving on the femur.
Dosage: Kaltenborn Grade II: distraction (tightening), moving w/in the SZ
range (and TZ when pain is relieved); perform sustained hold for 3-5
seconds and repeat for 10 reps total. After ~5 reps are performed, assess
PROM of knee/ankle mobility and pain, and then perform another 3-5
second sustained hold with 5 more reps, followed by another reassessment of
knee/ankle mobility and pain.
Dosage/Details
Pt position: Supine w/legs fully extended
PT position: Standing on the involved side, facing cranially. Grasp around
proximal tibia w/thumbs over anteromedial tibiofemoral joint space. Stabilize
distal tibia by slightly elevating the lower leg and placing it b/w your arm and
body.
Action: Provide sustained lateral-posterior force through medial meniscus
using hands to create a medial compression of the medial tibiofemoral
compartment as the pt. moves from knee flexion to extension.
Dosage: Perform 3-5 reps for 2-3 sets. Reassess knee mobility and pain after
each set.
Pt position: Supine w/legs fully extended
PT position: Standing on the involved side; place thumb over medial border of
the tibiofemoral joint line (parallel to tibial plateau) and reinforce w/the other
thumb.
Action: Have the pt. actively flex the knee and squeeze the meniscus
posteriorly into the joint space as you feel the joint space open.
Dosage: After the patient reports pain-free or demonstrates improved
movement with the stabilization, have the patient actively move through knee
flexion for 5-10 reps while applying the “squeezing” force.
8

3. Tibial Traction Apply a sustained traction
(Kaltenborn force of the tibia moving
Grade II) away from the femur. Once
pain relief is stated,
moving into the TZ will
allow for greater
extensibility of the tissues
and take up the slack of the
joint capsule. This will
assist in allowing for
improved pain-free knee
mobility.
Maddie Pedlar
Pt position: Prone w/feet off EOB. Knee needs to be in OPP (slight flexion).
PT position: Standing at EOB facing pt. w/hands around lower leg proximal to
ankle. Stabilize distal thigh w/hand or belt.
Action: Apply a sustained traction force of the tibia moving away from the
femur.
Dosage: Kaltenborn Grade II: distraction (tightening), moving w/in the SZ
range (and TZ when pain is relieved); perform sustained hold for 3-5 seconds
and repeat for 10 reps total. After ~5 reps are performed, assess PROM of
knee mobility and pain, and then perform another 3-5 second sustained hold
with 5 more reps, followed by another reassessment of knee mobility and pain.

BONUS (not required, but +2 point overall if all scenarios listed below are completed per the following instructions):
For each listed dysfunction above, consider a therapeutic exercise to correspond and build off your manual therapy
intervention. Must consider:
- purpose and dosing (dosing specific for joint or soft tissue extensibility to improve ROM, improving strength, or
increasing endurance)
- a potential progression and regression of your chosen exercise based on patient capabilities and symptoms. This might
mean considering additional causes or contributions to the dysfunction listed: (e.g., soft tissue extensibility or muscle
recruitment limitations contributing to ACJ pain and limitations with OH reaching). Be creative!!

1. Decreased FABER
a. Therapeutic exercise: clamshells (moving into hip Flexion, Abduction, and ER); pt. side lying w/knees bent
on top of each other (involved leg on top)
b. Purpose: to strengthen hip FABER muscles and improve hip flexion, abduction, and external rotation ROM
c. Dosing: perform 10-15 reps, repeat 2-3 sets; reassess FABER ROM b/w sets
d. Progression: add a Theraband around the distal thighs or ankle weight to the top leg to add a resistance
component
e. Regression: pt. short or long seated; externally rotate involved leg, then abduct to not have to work against
gravity

2. Lateral hip pain

a. Therapeutic exercise: Supine Lateral Hip Stretch w/stretch out strap or belt; pt. supine w/involved leg raised
up straight w/strap around midfoot, bringing leg towards the opposite side of the body to feel a good stretch
b. Purpose: to stretch lateral hip muscles to help improve flexibility for no pain w/movement
c. Dosing: Dosing: hold stretch for 30 seconds, 3 reps, 2 sets
d. Progression: Side lying hip abduction; pt. side lying on non-involved side, bringing LE up towards the
ceiling w/foot in neutral; perform 10 reps, 2-3 sets
e. Regression: Piriformis Figure-4 Stretch; pt. can be supine or seated, stretching out the piriformis muscle,
bringing involved leg over the opposite leg (90/90 position)

3. Limited hip ER and/or IR

a. Therapeutic exercise: Windshield Wipers; pt. seated on floor in a hooklying position, bringing knees down
towards the floor with a rotation of the hips (perform both ways to get IR/ER motion)
b. Purpose: to strengthen hip ER and IR muscles and improve hip ER and IR ROM
c. Dosing: perform 10 reps (5 reps each way), repeat 2-3 sets; reassess ER and IR ROM b/w sets
d. Progression: Standing Pendulum Leg Swings; pt. standing (can be in front of countertop for support) w/hip
and knee in 90o flexion, swinging leg to the outside and inside for IR/ER motion
e. Regression: Seated AROM of IR/ER of the hip w/leg at 90o hip flexion and knee flexion

4. Limited hip extension/presence of hip flexor stiffness

a. Therapeutic exercise: Hip Flexor Stretch; pt. half-kneeling w/one leg fully extended (go into a lunge
position) and push hips forward to feel a stretch in the hip flexors (repeat on other leg)
b. Purpose: to strengthen hip extensor muscles; to improve flexibility of hip flexor muscles
c. Dosing: hold stretch for 30 seconds, 3 reps, 2-3 sets (switch legs b/w reps)

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 Maddie Pedlar
d. Progression: Hip Flexor Stretch and Quad; pt. in a lunge position and bring up back leg to hold shin for a
greater quad stretch
e. Regression: Seated Hip Flexor Stretch; pt. seated on one side of the chair so one leg can extend back until
feeling a stretch in the quads.

5. Buttock pain
a. Therapeutic exercise: Piriformis Stretch; pt. supine w/knees in 90o flexion, crossing one leg over the other
(ankle over knee), pulling bent knee towards your chest so you feel a stretch in the buttock
b. Purpose: to stretch buttock muscles to help improve flexibility for no pain w/movement
c. Dosing: hold stretch for 30 seconds, 3 reps, 2-3 sets (switch legs b/w reps)
d. Progression: Bird Dog Stretch; pt. in quadruped, raising opposite arm and leg straight out (at shoulder
height); hold each side for 15 seconds and repeat.
e. Regression: Knee To Chest Stretch; pt. supine w/one leg bent in 90o hip and knee flexion, bringing it
towards the chest until feeling a stretch

6. Limited knee extension

a. Therapeutic exercise: LAQ; pt. seated w/lower legs off the table or chair to allow for full extension ROM
b. Purpose: to improve knee flexor muscle extensibility (hamstrings) to allow for improved knee extension
ROM
c. Dosing: perform 25 reps to incorporate NM re-ed and reassess knee extension AROM; repeat for 2-3 sets if
needed
d. Progression: standing terminal knee extension; pt. standing in front of countertop bending involved knee
slightly then bend knee back/press heel into the floor and raise toes (can add Theraband to provide resistance)
e. Regression: passive knee extension; pt. seated w/involved leg propped up on another chair (apply downward
force on distal thigh to improve knee extension ROM)

7. Limited knee flexion

a. Therapeutic exercise: AAROM Knee Flexion w/Towel; pt. supine w/towel wrapped around midfoot
b. Purpose: to improve knee extensor muscle extensibility (quads) to allow for improved knee flexion ROM
c. Dosing: perform 25 reps to incorporate NM re-ed and reassess knee flexion AROM; repeat for 2-3 sets if
needed
d. Progression: standing hamstring curls while pt. holds onto a countertop or chair for support; can add ankle
weights to incorporate resistance if able
e. Regression: heel slides; pt. supine

8. Patellofemoral restrictions
a. Therapeutic exercise: Quad sets; pt. long seated or supine w/towel roll beneath involved knee, contracting
quads, press knee into the bed and hold for 5 seconds.
b. Purpose: to strengthen muscles surrounding the patellofemoral joint to take off the load; improving strength
will allow for decreased tension on the joint
c. Dosing: perform 10 reps, 2-3 sets
d. Progression: Straight leg raises (can add ankle weight if able) to work against gravity; pt. supine w/involved
leg fully extended and uninvolved leg in 90o knee flexion
e. Regression: quadriceps stretch; supine or standing to increase extensibility of quad muscle tissue; hold for 30
seconds, repeat 3 reps for 2-3 sets.

9. Lateral knee pain and ankle dysfunction

a. Therapeutic exercise: glutes release on a foam roller; pt. sits on foam roller, bringing involved LE on
opposite knee (into a figure-4 position, bringing hip into ER); slowly roll back and towards the involved side
to get a good stretch (move slow and controlled) and hold stretch
b. Purpose: to loosen up tight glute muscles, IT Band, and relieve pressure on the lateral knee by increasing
muscle tissue extensibility and decreasing stiffness in proximal muscles
c. Dosing: hold stretch for 30 seconds, 3 reps, 2-3 sets
d. Progression: ITB release w/foam roller, focusing on lateral knee structures; pt. side lying w/involved LE on
foam roller and other foot fixed to the ground; move slow and controlled on foam roller
e. Regression: seated Figure-4 Stretch; stretch out gluteus medius and outside hip muscles by bringing
involved leg over the opposite leg (90/90 position)

10. Medial knee joint line pain and hypomobility

10
 Maddie Pedlar
a. Therapeutic exercise: butterfly stretch; pt. seated with legs in ER and feet together
b. Purpose: to loosen up tight inner thigh muscles and increase extensibility to allow for less pressure on the
medial joint line and improved mobility of the knee
c. Dosing: hold stretch for 30 seconds, 3 reps, 2-3 sets
d. Progression: standing lateral leg swings to target inner thigh muscles; perform 5-10 reps, reassess pain
w/mobility and repeat 2-3 sets.
e. Regression: perform one-sided butterfly stretch; ER involved leg, bringing heel to the midline of your body
and hold for 30 seconds.

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