Joint Mobilization: Hip Joint and Knee Joint

Introduction

This course describes joint mobilizations for the hip joint and knee joint (a.k.a. pelvifemoral joint, ichiofemoral joint, femorotibial joint, tibiofemoral joint, etc.). Several terms and definitions have been used to describe the "mobilizations" (e.g. mobilisations) that are taught in this course. The Brookbush Institute uses a conventional definition of "mobilization" that includes low amplitude, low-velocity, oscillatory techniques intended to reduce the stiffness of joints exhibiting a decrease in passive accessory range of motion (a.k.a. arthrokinematic motion and specifically glide or slide). Note, the term "manipulation" is reserved for high-velocity techniques taught in a separate set of courses.

This course includes several of the most commonly recommended techniques used to address hip joint and knee joint stiffness, and improve hip and knee range of motion (ROM). For example, research has demonstrated that hip joint mobilizations may be used to address a loss of hip rotation, increase gluteal muscle activity, and improve functional outcomes for hip osteoarthritis patients. These techniques may also be used in an integrated approach for lower extremity dysfunctions (LED) and lumbo pelvic hip complex dysfunctions (LPHCD) including iliotibial band syndrome, patellofemoral pain syndrome (PFPS), and hip impingement syndrome, and postural dysfunctions including knee valgus, knee varus, excessive forward lean, anterior pelvic tilt, or asymmetrical weight shift. Some evidence and clinical outcomes even suggest that addressing hip dysfunction can have a significant effect on ankle mechanics and heel strike during gait.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) with the intent of developing an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach.

Techniques Covered in this Course

• Knee Mobilization
• Hip Mobilization

Related Courses

Additional Joint Mobilization Courses

• Joint Mobilizations: Ankle and Tibiofibular Joints
• Joint Mobilizations: Knee and Hip Joints
• Joint Mobilizations: Lumbar Spine and Sacroiliac Joints
• Joint Mobilizations: Cervical and Thoracic Spine
• Joint Mobilizations: Shoulder, Sternoclavicular, and Acromioclavicular Joints
• Joint Mobilizations: Elbow and Proximal Radioulnar Joints

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Occupational Therapists - Intermediate
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

1. Harding, L., Barbe, M., Shepard, K., Marks, A., Ajai, R., Lardiere, J., & Sweringa, H. (2003). Posterior-anterior glide of the femoral head in the acetabulum: a cadaver study. Journal of Orthopaedic & Sports Physical Therapy, 33(3), 118-125.
2. Loubert, P. V., Zipple, J. T., Klobucher, M. J., Marquardt, E. D., & Opolka, M. J. (2013). In vivo ultrasound measurement of posterior femoral glide during hip joint mobilization in healthy college students. journal of orthopaedic & sports physical therapy, 43(8), 534-541.
   • Efficacy
3. Ju, T., Choi, W., Yang, Y., & Lee, S. (2015). Effects of Hip Mobilization on Pain and Function for Chronic Low Back Pain Individuals with Limited Range of Hip Joint Motion. Indian Journal of Science and Technology, 8(26), 1-6.
4. Beselga, C., Neto, F., Alburquerque-Sendín, F., Hall, T., & Oliveira-Campelo, N. (2016). Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: a randomised controlled trial. Manual therapy, 22, 80-85.
5. Cliborne, A. V., Wainner, R. S., Rhon, D. I., Judd, C. D., Fee, T. T., Matekel, R. L., & Whitman, J. M. (2004). Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. Journal of Orthopaedic & Sports Physical Therapy, 34(11), 676-685.
6. Currier, L. L., Froehlich, P. J., Carow, S. D., McAndrew, R. K., Cliborne, A. V., Boyles, R. E., … & Wainner, R. S. (2007). Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favorable short-term response to hip mobilization. Physical Therapy, 87(9), 1106-1119.
   • Comparing Interventions
7. Hoeksma, H. L., Dekker, J., Ronday, H. K., Heering, A., Van Der Lubbe, N., Vel, C., … & Van Den Ende, C. H. (2004). Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 51(5), 722-729.
8. Darnell, K., Harland, J., Casner, A., Kimball, T., & Tuong, D. (2017). A comparison between hip internal rotation mobilization to posterior glide and their effects on hip internal rotation.
9. Vaarbakken, K., & Elisabeth Ljunggren, A. (2007). Superior effect of forceful compared with standard traction mobilizations in hip disability?. Advances in physiotherapy, 9(3), 117-128.
10. Estébanez-de-Miguel, E., Fortún-Agud, M., Jimenez-del-Barrio, S., Caudevilla-Polo, S., Bueno-Gracia, E., & Tricás-Moreno, J. M. (2018). Comparison of high, medium and low mobilization forces for increasing range of motion in patients with hip osteoarthritis: A randomized controlled trial. Musculoskeletal Science and Practice, 36, 81-86.
    • Combining Interventions
11. Bade, M., Cobo‐Estevez, M., Neeley, D., Pandya, J., Gunderson, T., & Cook, C. (2017). Effects of manual therapy and exercise targeting the hips in patients with low‐back pain—A randomized controlled trial. Journal of evaluation in clinical practice, 23(4), 734-740.
12. Blackman, F., & Atkins, E. (2014). The effect of adding grade B hip mobilization to a muscle strengthening home exercise programme on pain, function, and range of movement in adults with symptomatic early-stage hip osteoarthritis: A pilot study for a randomized controlled trial. International Musculoskeletal Medicine, 36(2), 54-63.
    • Muscle Activity
13. Yerys, S., Makofsky, H., Byrd, C., Pennachio, J., & Cinkay, J. (2002). Effect of mobilization of the anterior hip capsule on gluteus maximus strength. Journal of Manual & Manipulative Therapy, 10(4), 218-224.
14. Makofsky, H., Panicker, S., Abbruzzese, J., Aridas, C., Camp, M., Drakes, J., … & Sileo, R. (2007). Immediate effect of grade IV inferior hip joint mobilization on hip abductor torque: a pilot study. Journal of Manual & Manipulative Therapy, 15(2), 103-110.
    • Self-administered
15. Walsh, R., & Kinsella, S. (2016). The effects of caudal mobilisation with movement (MWM) and caudal self-mobilisation with movement (SMWM) in relation to restricted internal rotation in the hip: A randomised control pilot study. Manual therapy, 22, 9-15.
    • Knee Efficacy
16. Moss, P., Sluka, K., & Wright, A. (2007). The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Manual therapy, 12(2), 109-118.
17. Zemadanis, K., Sykaras, E., Athanasopoulos, S., & Mandalidis, D. (2015). Mobilization-with-movement prior to exercise provides early pain and functionality improvements in patients with patellofemoral pain syndrome. International Musculoskeletal Medicine, 37(3), 101-107.
18. Hunt, M. A., Di Ciacca, S. R., Jones, I. C., Padfield, B., & Birmingham, T. B. (2010). Effect of anterior tibiofemoral glides on knee extension during gait in patients with decreased range of motion after anterior cruciate ligament reconstruction. Physiotherapy Canada, 62(3), 235-241.
    • Comparing Knee Interventions
19. Narang, S., & Ganvir, S. (2014). Efficacy of Kaltenbohn Mobilization on Patients with Osteoarthritis of Knee Joint. Indian Journal of Physiotherapy and Occupational Therapy, 8(3), 162.
20. Raghav, S., Singh, A., Tyagi, G. P., & Rastogi, K. The Effect of Mobilization with Movement versus Conventional Treatment on Range of Motion in Patients with Post-Traumatic Stiffness of Knee Joint: A Randomized Clinical Trial.
21. Lalit, S. Y., Suhas, M. B., & Amita, M. (2012). Effect of Manual Therapy Techniques on knee Proprioception in Patients with Osteo-arthritis of knee. Indian Journal of Physiotherapy and Occupational Therapy, 6(3), 285.
22. Sambandam, C. E., Sailor, S. N., & Alagesan, J. (2011). Effect of Mulligan Mobilization and Maitland Mobilization in Subjects with Unilateral Tibiofemoral Osteoarthritis-Randomized Controlled Trial. Journal of Pharmaceutical and Biomedical Sciences, 11(11), 1-4.
23. Kostov, R., & Ilieva, B. (2016). Results of implementation of the joint mobilization techniques to restore mobility of the knee complex in patients after partial meniscectomy. Scripta Scientifica Medica, 48(1), 30-35.
24. Oskay, D., Altmış, H., Düzgün, I., & Elbasan, B. (2015). THU0618-HPR Immediate Effects of Mulligan's Concept Mobilization with Movement on Knee Pain and Functions in Patients with Knee Osteoarthritis.
25. Demirci, S., Kinikli, G. I., Callaghan, M. J., & Tunay, V. B. (2017). Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain. Acta orthopaedica et traumatologica turcica, 51(6), 442-447.
26. Giri, P. (2019). THE EFFECT OF MULLIGAN TECHNIQUE IN COMPARISON WITH MAITLAND MOBILIZATION AND KINESIO TAPING IN PATIENTS WITH OSTEOARTHRITIS OF KNEE JOINT.
27. Mutlu, E. K., Ozdincler, A. R., & Ercin, E. (2015). Comparison of two different mobilization techniques in the management of osteoarthritis of the knee: A randomized clinical trial. Osteoarthritis and Cartilage, 23, A391-A392.
28. (also used below) Kaya Mutlu, E., Ercin, E., Razak Ozdıncler, A., & Ones, N. (2018). A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: a randomized three arm clinical trial. Physiotherapy theory and practice, 34(8), 600-612.
29. Rao, R. V., Balthillaya, G., Prabhu, A., & Kamath, A. (2018). Immediate effects of Maitland mobilization versus Mulligan Mobilization with Movement in Osteoarthritis knee-A Randomized Crossover trial. Journal of bodywork and movement therapies, 22(3), 572-579.
30. Jadhav, V. S., & Anap, D. B. (2019). Effectiveness of Mulligan Mobilization Versus Mckenzie Exercises in Knee Osteoarthritis: A Single Blind Randomized Controlled Trial. Physiother Rehabil, 4(177), 2.
31. Rangey, P. S., Sheth, M. S., & Vyas, N. J. (2015). Comparison of Immediate Effect of Two Different Maitland Mobilization Protocols on Pain and Range Of Motion in Subjects with Osteoarthritis of Knee. Pain, 6, 8.
    • Mobilization and Exercise
32. Razek, R. A., & Shenouda, M. M. (2014). Efficacy of mulligan's mobilization with movement on pain, disability, and range of motion in patients with knee osteoarthritis: A randomized controlled pilot study. Indian Journal of Physiotherapy and Occupational Therapy, 8(1), 242.
33. Ko, T., Lee, S., & Lee, D. (2009). Manual therapy and exercise for OA knee: effects on muscle strength, proprioception, and functional performance. Journal of Physical Therapy Science, 21(4), 293-299.
34. Dwyer, L., Parkin-Smith, G. F., Brantingham, J. W., Korporaal, C., Cassa, T. K., Globe, G., … & Tong, V. (2015). Manual and manipulative therapy in addition to rehabilitation for osteoarthritis of the knee: assessor-blind randomized pilot trial. Journal of manipulative and physiological therapeutics, 38(1), 1-21.
35. Kappetijn, O., van Trijffel, E., & Lucas, C. (2014). Efficacy of passive extension mobilization in addition to exercise in the osteoarthritic knee: an observational parallel-group study. The Knee, 21(3), 703-709.
36. Singh, D. (2012). An Experimental Study on effects of Mulligan Mobilization Technique and Isometric Exercises in Patients with Osteoarthritis Knee. Indian Journal of Physiotherapy & Occupational Therapy, 6(4).
37. Deyle, G. D., Henderson, N. E., Matekel, R. L., Ryder, M. G., Garber, M. B., & Allison, S. C. (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of internal medicine, 132(3), 173-181.
38. Deyle, G. D., Allison, S. C., Matekel, R. L., Ryder, M. G., Stang, J. M., Gohdes, D. D., … & Garber, M. B. (2005). Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical therapy, 85(12), 1301-1317.
    • Mobilization and Conventional Physical Therapy
39. MN, N. A., & LYN, K. (2011). Effects of passive joint mobilization on patients with knee osteoarthritis. Sains Malaysiana, 40(12), 1461-1465.
40. Kulkarni, A. V., & Kamat, M. M. (2017). A Study to Determine the Effectiveness of Mobilization with Movement Techniques in Knee Osteoarthritis Pain. International Journal of Health Sciences and Research, 7(4).
41. 남용이, 춘숙권, & 현승송. (2015). The effect of manual joint mobilization on pain, ROM, body function and balance in patients with knee osteoarthritis. Korean Society of Physical Medicine, 10(4), 91-99.
42. Pollard, H., Ward, G., Hoskins, W., & Hardy, K. (2008). The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. The Journal of the Canadian Chiropractic Association, 52(4), 229.
43. Fish, D., Kretzmann, H., Brantingham, J. W., Globe, G., Korporaal, C., & Moen, J. R. (2008). A Randomized Clinical Trial to Determine the Effect of Combining a Topical Capsaicin Cream and Knee-Joint Mobilization in the Treatment of Osteoarthritis of the Knee. Journal of the American Chiropractic Association, 45(6).
44. Lluch, E., Duenas, L., Falla, D., Baert, I., Meeus, M., Sanchez-Frutos, J., & Nijs, J. (2018). Preoperative pain neuroscience education combined with knee joint mobilization for knee osteoarthritis. The Clinical journal of pain, 34(1), 44-52.
    • Taping
45. Park, S. J., & Lee, J. H. (2016). Effect of joint mobilization and kinesio taping on pain, range of motion, and knee function in patients with knee osteoarthritis. The Journal of Korean Physical Therapy, 28(5), 279-285.
46. Park, S. J., & Kim, D. D. (2017). The impact of joint mobilization with an elastic taping on immediate standing balance in patients with knee osteoarthritis. Journal of the Korea Convergence Society, 8(7), 295-304.
47. Altmış, Hülya, Deran Oskay, Bülent Elbasan, İrem Düzgün, and Zeynep Tuna. "Mobilization with movement and kinesio taping in knee arthritis—evaluation and outcomes." International orthopaedics 42, no. 12 (2018): 2807-2815.
    • Knee Mobilization and Analgesia
48. Courtney, C. A., Steffen, A. D., Fernández-De-Las-Peñas, C., Kim, J., & Chmell, S. J. (2016). Joint mobilization enhances mechanisms of conditioned pain modulation in individuals with osteoarthritis of the knee. journal of orthopaedic & sports physical therapy, 46(3), 168-176.
49. Courtney, C. A., Witte, P. O., Chmell, S. J., & Hornby, T. G. (2010). Heightened flexor withdrawal response in individuals with knee osteoarthritis is modulated by joint compression and joint mobilization. The Journal of Pain, 11(2), 179-185.
    • Knee Mobilization and Muscle Activity
50. Ghanbari, A., & Kamalgharibi, S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences (IJHRS), 2(4), 186-91.
    • Self-administered Knee Mobilization
51. Takasaki, H., Hall, T., & Jull, G. (2013). Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis–A prospective case series. Physiotherapy theory and practice, 29(2), 87-95.