Today a past patient came in with a total knee replacement. The woman had been in before, and had previously recieved treatment, from my supivisor. My supivisor asked me to perform an AP on her tibial tuberosity.
I wasn't patricularily anxious about this patient as i was being watched by my supivisor, and i was quiet familiar with these mobilisations as we have already performed these in our UL musculoskeletal unit.
We performed an AP on her tibial tuberoisty, and a medial glide to her patella to loosen up the ligamentus/ muscular structures ( surrounding the tibiofemoral joint)and improve her ROM. We then performed stretches to her quadriceps and gave her a session of interferential to deal with any pain she was feeling and also to improve the blood flow to the injury site.
During treatment; the woman complained of pain in her knee; i believe as my supivisor later told me that i was performing the AP with "a little to much enthusiasm" and possibly she could have felt pain on her bony prominance, from the constant pressure. He advised me next time to "move my hand placement but still glide in the same joint line plane; in order to spread out the pressure".
Otherwise i was generally happy with the way things progressed today! :).
For furuture cases I think i need to have another look at one of my anatomy books; it seems that particularily in musculoskeletal physiotherapy you need to know your surface anatomy VERY WELL!.
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