How’s it going Modern Manual Therapy viewers. Dr. E here back at EDGE Rehab and Sport Science in Hamburg New York with Dr.
Dana Palmer my co-host my, one of my co-hosts of Untold Physio Stories podcast and a mentee
in the current Modern Rehab Mastery cohort. So I’ve been having some issues
with my knee some painful clicking and it reminded me of a meniscal technique
that I don’t really get to do too often but basically if you see someone with
like a kind of classical meniscal presentation they have clicking in
their knee with closed chain activities. Maybe they had some kind of twisting
injury or it’s worse with flexion and twisting and closed chain. I’m not going
to go over the you know meniscal special tests that may or may not have
great sensitivity or specificity but if someone has clicking and they have pain
and potentially a springy type end feel and indicating like an internal
derangement with passive knee extension. I like to do an old-school Cyriax
technique that I learned from my mentor in fellowship. So you can flip over
prone Dana. And normally you the traditional instruction was to strap
down the involve thigh so if Dana’s right knee had the clicking and she had pain
with flexion or twisting activities and she had a loss of passive extension with
a springy end feel with or without a springy end feel but
definitely pain at end range. What you could do is just traction the leg and
again if you could strap this down that would be great but it’s not necessary.
You could also start with traction and go a little like this and then just initially
twist and eventually get down to grabbing right above the malloli and
twisting while tractioning and just scoot this way so your foot
goes off the table so you can bring someone into terminal extension. Now
sometimes you may hear a click and hopefully that click isn’t with every
rep. That click that you may feel will ideally under the right circumstances
it just happened once. Qhich if it only happens once and you continue to go into
end range and that combination of traction is enough to modulate pain with end range
over pressure into extension. Then that should be enough to desensitize it and
again hopefully with the distraction and the tibial rotations you’re able
to reduce any kind of maybe flap that was sticking up and internally the
deranging the joint. So after a couple of sets of that if it doesn’t reduce in say
a couple sets of ten extensions. Then you might have to do something else but if
it is successful and your any of your traditional kind of meniscal tests
should be clear. Plus, mainly the hyperextension should now be pain-free
and if there was a springy end feel indicating internal derangement then now
it should be firm like it’s supposed to be. So again this is an old-school
technique and usually it’s quite a bit more pathoanatomical than what you
normally see here on Modern Manual Therapy but if you like this technique
and if you find it useful definitely chime in in the comments if
you have any alternative kind of meniscal reduction techniques. Definitely
post them and leave in the comments. For home exercise program it’s pretty simple
after you restore extension they can just do repeated terminal knee
extensions ten times hourly throughout the day. And just make sure to eventually load in
flexion because previously that was probably what was limited in function.
All right. Ao subscribe to my Modern Manual Therapy on Facebook, Instagram, YouTube.
Check out Untold Physio Stories podcast with myself, Dr. Dana Palmer and Dr.
Andrew Rothschild. Check out all my courses modmt.com/coursecalendar and all my sites are in modmt.com/sites I have EDGE Mobility System my ecommerce store with IASTM, BFR, full online
seminars and more and as always please share Modern Manual Therapy to all your
friends and colleagues. Have a great day!