 Externally rotated
Motion Restriction: Internal rotation of tibia
- Patient is prone on the table with the operator standing at the side of the dysfunctional extremity
- Operator flexes the knee to 90 degrees and grasps the heel and the forefoot of patient.
- Operator dorsiflexes the ankle and internally rotates the tibia to the barrier.
- Patient externally rotates the forefoot against operator resistance for 3-5 seconds and three to five repeitions.
- Following each patient effort, the operator internally rotates the foot to the new barrier.
Are you treating Tibial rotation limitations in multiple stages of flexion?
Considering the obvious fact that the knee experiences a large excursion in flexion angles during sporting activity and also that patella contact pressures change as a result of knee flexion angle, (“Earlier in vitro studies have demonstrated that, in weight bearing, contact pressures within the patellofemoral joint increase as the knee flexes from 0 to 90 and decrease as the knee extends.” Lee, 2003), it is clearly warranted to treat limitations in both normal tibio-femoral along with patella and patellar tendon mobility in these various degrees of motion, and not simply in the traditional supine, table supported manner.
Closing Thoughts: Evaluating knee rotation is a critical part of any comprehensive knee pain evaluation, especially for those evaluations involving pain and swelling of a “non-specific” origin (aka: patellofemoral pain syndrome). For those that are familiar with the SFMA, limitations in multi-segmental rotation can be evaluated in a minimal amount of time and will lead you directly to this rotational component should a limitation exist. Treating this limitation should reflect the knee angle in which the restriction actually corresponds to.
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- Greenman’s Principles of Manual Medicine, Fourth Edition.
- Kapandji, AI. The Physiology of the Joints. Volume Two. The Lower Limb. Churchill Livingstone Elsevier. 2006.
- Lee TQ, Morriss G, Cstinalan R. The Influence of Tibial and Femoral Rotation on Patellofemoral Contact Area and Pressure. J Orthop Sports Phys Ther. 2003;33(11):686-693.
- Lee TQ, Yang BY, Sandusky MD, McMahon PJ. The effects of tibial rotation on the patellofemoral joint: assessment of the changes in in situstrain in the peripatellar retinaculum and the patellofemoral contact pressures and areas. J Rehabil Res Dev. 2001;38:463-469.
- Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ. The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res. 2004;22:801-806.