The Mulligan Concept in the Treatment of Anterior Knee Pain

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 (playing, weight lifting, and conditioning) 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 Disability of the Physically Active Scale, the Numeric Pain Rating Scale, and the Patient Specific Functional Scale were used to identify patient-centered, as well as clinician-centered changes produced by the treatment intervention. Recording of outcome measures took place at the initial assessment, after the initial treatment intervention, two days after the initial intervention, and one and two weeks after the initial 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. The purpose of this 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 Phrases Manual techniques, patient-reported outcomes, mulligan concept, sub-therapeutic dose Correspondence Dr. Karla Judge, Idaho State University, 921 South 8th Ave, Pocatello, ID, 83209 Email: judgkarl@isu.edu Full Citation Judge KS, Nasypany A, Baker RT, May J. The Mulligan Concept in the Treatment of Anterior Knee Pain. Clin Pract Athl Train. 2019;2(3):48-57. https://doi.org/10.31622/2019/0003.5. Submitted: November 29, 2018 Accepted: October 18, 2019