8/29/2010

Manual Examination and

Orthopaedic Manual Physical Therapy
Treatment
Interventions for Osteoarthritis of the Hip
and Knee:
of the Knee
An Evidence-Based Approach
Gail Deyle
Skip Gill
Dan Rhon
Ben Hando

Step-up and Squat

Functional
Examination

Active to Combined Movements

with End Range Overpressures

Lumbar Screen

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Central and Unilateral

P-A Accessory Movements

Manual Examination
of the Knee

Knee Flexion Knee Extension

Posterior Directed Force

Knee Extension Knee Extension

Adduction Abduction

Posterior Lateral Directed Force Posterior Medial Directed Force

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Flexion/IR/Abd Flexion/ER/Add

Posterior Lateral with Int Rotation Directed Force Posterior Medial With Ext Rotation Directed Force

Patella Medial Glide Patella Lateral Glide

Medial Directed Force Lateral Directed Force

Patella Caudal Glide Patella Cephalad Glide

Superior Directed Force

Inferior Directed Force

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Patella Rotation
Lachman
Glide

Rotation Forces Either Direction

Quadriceps Length

Manual Examination

Muscle Length

Stabilize Pelvis

Hip Flexor Length TFL/ITB Length

Stabilize Pelvis
Stabilize Pelvis

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Hamstring Length Gastroc/Soleus Length

PROM Hip Extension

Manual Examination

Hip Screen

PROM to Combined
Movements Flex/Add
Manual Treatment
of the Knee

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Knee Extension Grade Knee Ext/Abd

IV Grade IV

Posterior Directed Force Posterior Medial Directed Force

Knee Ext/Add
Grade IV Knee Ext Grade III

Posterior Directed Force

Posterior Lateral Directed Force

Knee Extension Grade

Knee Ext/Abd III
III

Posterior Medial Directed Force

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Knee Ext/Abd III Knee Ext/Add III

Posterior Lateral Directed Force

Knee Ext/Add III Knee Ext/ER IV

Femur Posterior Force, Tibia External Rotation Force

Knee Flexion
IR in 90 to Full Flexion
Grade IV

Tibia Internal Rotation Force

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Knee Flexion Grade IV Patella Medial Glide

with Popliteal Wedge Grades III & IV

Medial Directed Force

Patella Lateral Glide Patella Caudal Glide

Grades III & IV Grades III & IV

Inferior Directed Force

Lateral Directed Force

Patella Ceph Glide Patella Caudal Glides

Grades III & IV Grades III & IV

Superior Directed Force

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Patella Rotation
Glides Grade IV

Rotation Directed Force Either Direction

Patella Rotation A-P Fibula Head

Glides Grade IV Grade IV

Anterior to Posterior Directed Force

P-A Fibula Head

Grade IV
Manual Muscle
Stretching

Posterior to Anterior Directed Force

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Quadriceps Stretch Hip Flexor Stretch

Stabilize Pelvis Stabilize Pelvis

Hamstring Stretch Calf Stretch

Soft Tissue Massage

TFL/ITB Stretching

Stabilize Pelvis Suprapatellar Region Frequently Involved

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Hip Extension
Grade IV

Hip Interventions

Hip Flex/Add
Grade IV
Lumbar Interventions

Central and Unilateral Lumbar Local Rotations

P-A Accessory Movements Grade IV-V

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Static Quad Exercises

SQS with heel
Deyle et al. OA Knee propped and foot in
DF
Home Exercise Program 10 second hold
pushing knee down
and straight

Strengthens quad and

challenges knee
flexion contracture

Hamstring Stretch Prone Quad Stretch

DF foot and extend Maintain posterior
knee with pelvic tilt
contralateral hip and
knee straight Use strap or belt to
gently flex knee until
Hold 30-60 seconds pull is felt in the
quadriceps
Repeat x3
Hold 30-60 seconds
Should be easily
tolerated Repeat x 3

Repeated 3 Second Challenges to

Calf Stretch Full Extension: Repeat x 10 x 2

Knee straight foot

pointing straight
forward

Lean forward until

pull is felt in calf

Hold 30-60 seconds

Repeat x3

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Terminal Knee Extension with

Repeated 3 Second Challenges to
Quadriceps and Gluteal
Full Flexion: Repeat x 10 x 2
Contractions

Assisted Mini Squats

Feet pointing forward

Closed Chain Squat to about 30 knee

flexion, knees over 2nd
Progression toes

Use quads and gluts to

push upright with quads
and gluteal muscles and
hold isometrically

Challenge hip and knee

flexion contractures

Single Leg Assisted

Step-ups
Mini Squats

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