The patient is a 63-year-old Caucasian female (BMI-normal) seen in an outpatient clinic post left knee arthroplasty (2 weeks). The patient-reported considerable medial knee pain (VAS-9/10) with active knee range of motion testing. The range was restricted from 5° of flexion to 64° of flexion, with the patient demonstrating an antalgic gait pattern [9]. The X-rays and ultrasound performed post-knee arthroplasty were negative for prosthetic alignment and deep vein thrombosis. The patient denied any low back, hip, and ankle pain but demonstrated extreme tenderness to palpation in the anteromedial knee [10]. The surgical site of the incision was closed, and the wound edges were approximated and were not tender to palpation. Tinel’s sign performed on the saphenous nerve reproduced the symptoms of numbness/tingling and severe pain in the anteromedial knee with radiation to inferior patellae. The functional outcome scales showed 42/80 (lower extremity functional scales) with difficulty in most functional activities. Due to extreme anterior-medial knee pain, the patient showed reluctance to rehabilitation and exercises. Soft tissue mobilizations such as deep friction to the palpable neuroma and neurodynamic flossing techniques targeting saphenous demonstrated significant improvement [11, 12] (Figs. 1 and 2). This approach was followed by gradual active, and passive rehabilitation focused on improving range of motion, strength, and joint mobility during the same visit (Figs. 1 and 2).
After two appointments (VAS-1/10) of soft tissue mobilizations and neuro-dynamic flossing techniques, the patient showed significant improvement in anteromedial knee symptoms. Soft tissue mobilization was performed perpendicular to the saphenous neuroma for 5 min and 6 min, respectively, during the 1st and 2nd visits. The dosage of soft tissue mobilization was performed considering the patient’s tolerance levels. The saphenous flossing was conducted in the mid-range for 2 min each without aggravating the symptoms. Tensioning techniques were not tried considering the acuteness of symptoms. The re-evaluation was performed on the 8th visit after 4 weeks of biweekly appointments. The 4-week follow-up demonstrated an improved range of motion from 0 to 94° of flexion with functional outcome scale improving to 52/80 [13] (lower extremity function scale).