The Mulligan Concept in the Treatment of Anterior Knee Pain

Abstract

ABSTRACT
The purpose of the disablement model case study was to describe the case of a collegiate basketball player suffering from anterior knee pain (AKP). The patient had been experiencing AKP while participating in pre-season basketball related activities  for approximately six weeks. As the intensity increased, the pain became intolerable. Previously, the patient had missed a significant amount of off-season workouts due to surgery for an upper extremity injury sustained during the competitive season. The patient reported tenderness at the inferior pole of the patella, and at the tibial tuberosity. There was no joint line tenderness, swelling, tissue temperature change, crepitus, or joint locking identified during the initial assessment. Manual muscle testing revealed decreased strength and pain at the inferior pole of the patella and the tibial tuberosity with the long sitting straight leg raise, as well as seated knee extension. Patient reported outcome measures were used to establish a baseline of pain and function. The DPAS , the NPRS,  and the PSFS were used to identify patient-centered, as well as clinician-centered changes produced by the treatment intervention.  Outcome measures reflected a positive result for the decrease of pain with basketball activities, as well as activities of daily living. Evidence supports the use of mobilizations to treat tendinopathies, joint positional faults and neuromuscular motor control. While evaluating and treating patients with the Mulligan Concept MWM, the clinician receives immediate feedback regarding the efficacy and potential success of the intervention strategy. A goal of this disablement model case study was to describe the application of the Mulligan MWM philosophy and tibial internal rotation (TIR) technique while treating a patient complaining of AKP in an intercollegiate athletic training clinic.

Key Words: Manual Techniques, Patient-Reported Outcomes, Mulligan Concept, sub-therapeutic dose