According to mainstream orthopedics, knee complaints are usually diagnosed as patellar tendinopathies, patellofemoral pain syndrome (PFPS), iliotibial band syndrome (ITBS), bursitis, arthritis, and various structural lesions such as tears in the menisci, ligaments, or cartilage. There are less frequent diagnoses as well like Osgood-Schlatter disease and fractures.

These diagnoses are made via clinical tests called orthopedic special tests (OSTs) and imaging (x-ray & MRI).

While I use OSTs and imaging when needed, the most important test I use for diagnosing is repeated movement testing, developed decades ago by Robin McKenzie. By using repeated movement testing of the knee (and possibly spine), I find the majority of knee complaints are caused by a mechanical joint problem - either in the knee or the spine. This diagnosis of joint derangement, which is resolved by finding the direction the joint needs, does NOT exist in mainstream orthopedics since most clinicians have not learned McKenzie's work. (I was not taught about his ideas in school, for example.) Think of a joint derangement as a tweaked joint that responds to a certain movement to "get back on track."

Repeated movement testing (an algorithm that is based initially on the verbal history, the orthopedic physical exam, and knowledge of prevalence and patterns) will, in my mind, more accurately diagnose the root cause. If the diagnosis is a joint derangement, the matched treatment is repeated movement into the direction that resolves symptoms & signs.

For spinal joint derangements (which can refer or create pain anywhere in the lower extremity), the movement is a spinal movement. For knee joint derangements, the movement is a knee movement. A specific form of knee extension or flexion is commonly the movement that is needed, but sometimes we need extension or flexion with a rotational component, as demonstrated here.

Repeated movement testing reveals, of course, if the problem is not a joint derangement. If the diagnosis is indeed a tendinopathy, a structural lesion, or arthritis, for instance, I apply the appropriate matched treatment. I argue that the diagnoses PFPS or ITBS do not exist as clinicians maintain.

In conclusion, a diagnosis is only as good as the tests it’s based on. By including repeated movement testing in my orthopedic evaluation, I find I can better diagnose disorders (most are mechanical joint problems!) and therefore better apply the matched treatment.

For more information on knee pain resolved with repeated knee movements, here's a 2013 study:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3578196/

For more information on knee pain resolved with repeated spine movements, here's a 2020 study:
www.ncbi.nlm.nih.gov/pmc/articles/PMC8550529/

For more information on using repeated movement testing with patients with knee pain (and knee arthritis present on imaging), here’s a 2014 study:
www.jospt.org/doi/10.2519/jospt.2014.4791?url_ver=…

Dr. Laura Mannering DPT, OCS, Dip MDT
Doctor of Physical Therapy
Board-certified in Orthopedic Physical Therapy
Diploma in MDT (McKenzie's Mechanical Diagnosis and Therapy)

Website: www.drlauramannering.com/
Instagram: www.instagram.com/drlauramannering/

Clinic located in Dupont Circle in downtown Washington, DC.

#orthopedics #kneepain #knee #physicaltherapy #kneepainrelief