A stubborn Dad

[nasde]

I'd clear the hamstrings and calf - they are often tight and a cause of pain at the back of knee joint. I'd do that with any soft tissue technique to the patient in prone. Good in general for most knees i find, and then stretching for calf and hamstring.

do all the Patello-fem stuff too.

[milo]

How long has your dad had this problem?

Does going down stairs with the bad leg leading or lagging cause pain?
Bad leg leading - may indicated tib/fem joint, meniscal issues as the knee is extended and weight is taken through it.
Bad leg lagging - may indicate patella mal-tracking causing the pain as it struggles to eccentrically load the weight.

[Njorl]

Hi Thanks for your reply,

My Dad said that when he climbs into his works van he pulls himself up with the steering wheel as hurts if puts weight through from that height and I think must lack strength also. He has very limited plantarflexion and looks generally stiff and tight from sustained postures and activities for amny years. Thanks for reply.

[schischka]

Hi there....

I guess when we hear "pain up or down stairs" we think patellofemoral. But I believe you need to try and really reproduce his pain with special knee tests. It sounds like it is bothering him alot and if he has constant pain and he feels it deep and behind his knee, I'd tend to think more knee joint dysfunction (?meniscus/?OA). Another good point someone made is to get a good history!!

If you are confident it's patellofemoral, I'd agree with the other replies regarding management.

All the best as you nut out your patients