Optimizing Lower-Limb Biomechanics: The Role of Hip, Knee, and Ankle Mobilization in Knee Pain—A Case Report on Pain Reduction, Strength Improvement, and Functional Recovery

A bstract Chronic knee pain, particularly pain associated with pes anserinus bursitis, is commonly treated using localized therapeutic approaches. However, because of the interdependence of the lower-limb kinetic chain, dysfunction in proximal and distal joints may contribute to persistent symptoms. Therefore, addressing impairments at the hip and ankle, in addition to the knee, may improve clinical outcomes. This case report examined the effect of targeted hip, knee, and ankle mobilization on pain, muscle strength, plantar pressure distribution, and functional performance in a patient with chronic pes anserinus bursitis. A 43-year-old woman presented with a 12-year history of chronic right knee pain following a traumatic bicycle collision. She reported persistent functional limitations and abnormal gait despite previous conventional physiotherapy. Clinical examination revealed localized tenderness over the pes anserinus region, altered weight-bearing patterns, and compensatory movement strategies involving the hip and ankle. The patient underwent a 3-week targeted rehabilitation program consisting of figure-of-eight knee traction with internal rotation, hip external-rotation mobilization glides, ankle dorsiflexion glides, and progressive lower-limb strengthening exercises. Following intervention, the Knee Injury and Osteoarthritis Outcome Score pain subscale improved from 45 to 78 (73.3%). Quadriceps and hamstring strength increased while plantar pressure mapping demonstrated a more symmetrical medial-lateral load distribution. Functional performance also improved, with Timed Up and Go Test time improving by 26.1%. This case highlights the effectiveness of a kinetic-chain approach in the management of chronic knee pain. Targeted mobilization and strengthening of the hip, knee, and ankle reduced pain and improved functional performance and lower-limb alignment.