Updated: Oct 23, 2020
A patient presents with limited L knee extension by 30 degrees and lacking 10 degrees of flexion compared to the other side which presents as pain with walking and limits their ability to squat and pick things up from the floor. In supine, patient presents with + SLR on L>R and shows limited hamstring extension from 90/90 supine. + Ober's and Thomas test on LLE. Patient demonstrates aberrant tissue tension along quadriceps more distally, rather than proximal and has increased tissue tension along medial hamstrings and adductors which causes pain when touched. Patient has decreased patellar mobility in all directions. Patient has normal quad strength and decreased hamstring and glute max/med strength. When performing squats, patient shows a quad dominant and excessive knee flexion and slight genu valgus contributing to R anterior/medial knee pain.
If I were this patient, here are the things that I would want to focus on.
To start: I want to address the things that I've found to be limited.
Limited knee flexion / extension = work on Range of Motion
Tight hamstrings, quads, hip flexors = stretch
ROM and motor control:
Seated elevated hanging for knee extension
Seated hamstring stretch with overpressure
Standing hamstring stretch with overpressure
Tissue work and joint mobility:
Massage: quads, hamstrings, and patellar glides in all directions
Squats: done with hip hinge and working on preventing knees from moving inwards.
Plan: for the following sessions, I want to continue to monitor glute strength and quad mobility and hip extension range of motion.