The patient appeared to be a healthy 64-year-old white male. The patient's surgical history included a right ankle fracture with fixation 23 years ago. The patient reported well-controlled hypertension with medication as the only health problem. System Examination Integumentary System During examination of the integumentary system, swelling was noted in bilateral knees. Bilateral swelling was measured by taking the circumference of the upper and lower patella of both knees. Left knee swelling was measured at 44.5 cm and 41.0 cm at the upper and lower patella, respectively. Right knee swelling was measured at 43.5 cm and 39.0 cm respectively. The incisions on both knees were closed and well healed. The patient reported no numbness or tingling in bilateral lower extremities; the sensation has therefore not been tested. All other systems were insignificant. Approach The patient declared before his surgery that he did not use a functional device. He said he only needed to use the cane when walking long distances to improve his balance and stability. He said his legs get tired after long periods of walking. When gait was examined, the patient walked without a cane. He presented a slightly analgesic gait, leaning to the right with a reduction in support on the left lower limb. In addition to a mildly analgesic gait, the patient presented normal and coordinated movement patterns. When measuring walking speed, the patient walked safely at 263 ft/min. The patient's balance was tested by placing him upright in tandem. The patient was able to stay in tandem position for more than 30 seconds with the left and right feet forward, indicating that the patient had good balance.PainThe patient's pain was assessed...... middle of paper ... ...and endurance, manual therapy to decrease pain and increase range of motion, augmented soft tissue mobilization (ASTYM) to break down scar tissue and help regenerate new healthy tissue, neuromuscular reeducation for increase balance and proprioception and a home exercise program. The patient was to be seen in the outpatient clinic twice a week for four weeks. After four weeks, the patient was reassessed and the surgeon approved continuation of treatment twice a week for an additional three weeks. Interventions During the six weeks of treatment of the patient by the physiotherapy student, general bilateral lower limb strengthening and stretching exercises were introduced to the clinic as well as manual therapy of both lower limbs. Each treatment session lasted 60 minutes. A home exercise program was also established for the patient.