Thankyou for your replys. Following your comments I assesed his lumbar spine, he has stiffness at L4/5 and whilst treating his lumber spine and he reported a sensation in his knee during mobilisation.

The patient is aged 58. The pain was insidious onset and he has had a history of around 3months.I have assesed his ankle and there are no problems there.

I am also treating him for neck pain/ache. Which is related to a trigger point in upper-trapezius and some tenderness over C4/5. He also has a forward head posture. I have been doing TrP release, and lots of soft tissue work, aswell as stretching, Csp mobs and DNF exs.

I am starting to question my effectiveness with this patient and am wondering how much is due to psychological and OA factors...

I am considering if there is no progression this week I shall recommend glucosamine and refer him on to a personall trainer for general fitness.