From one recorded visit to the work that follows.

Reports right anterior knee pain rated 3/10 with stair descent and 1/10 at rest. Symptoms are less frequent than at the previous visit. Able to walk 30 minutes and complete two flights of stairs with improved confidence. Completed the home program five days this week with mild muscle fatigue and no lasting symptom increase. Denies new trauma, locking, giving way, night pain, or other new concerns. Goal remains a comfortable return to recreational running.

• Observation: Trace right dynamic knee valgus during step-down; gait non-antalgic.
• Range of motion: Knee flexion 137 degrees right and 140 degrees left; extension 0 degrees bilaterally.
• Strength: Knee extension 4+/5 right and 5/5 left; hip abduction 4/5 right and 4+/5 left.
• Functional testing: Ten controlled single-leg sit-to-stands from elevated plinth with mild loss of frontal plane control after repetition seven. Step-down pain 2/10, previously 4/10.

Confirmed consent to assessment and treatment. Manual therapy included right patellofemoral medial and lateral mobilizations, grade III, 3 sets of 45 seconds; tibiofemoral posterior glide, grade III, 3 sets of 45 seconds; and soft tissue mobilization to the distal quadriceps and lateral retinaculum for 6 minutes. Active treatment included supported split squat 2 sets of 8 per side and lateral step-down 2 sets of 6 for movement control. Provided education on symptom-guided loading and activity pacing. Knee flexion improved to 140 degrees and step-down pain decreased to 1/10 after treatment. No adverse response reported.

Presentation remains consistent with right patellofemoral pain and lower-extremity load intolerance. Improving stair tolerance, symptom irritability, and repeated functional loading indicate progress toward goals. Positive short-term response to manual therapy and focused exercise suggests mobility and load tolerance remain modifiable. Residual hip abductor and quadriceps endurance deficits continue to affect single-leg control. Current findings support continued hands-on treatment combined with progressive strengthening and graded return to impact activity.

Continue physiotherapy once weekly for three weeks. Reassess patellofemoral mobility and use manual therapy as indicated to support comfortable loading. Progress split squat and step-down resistance if symptoms remain at or below 3/10 and settle to baseline within 24 hours. Add walk-jog intervals when the patient completes 10 controlled single-leg squats and tolerates stairs without symptom escalation. Reassess knee extension strength, single-leg control, and running readiness at the next visit. Home program updated and reviewed with the patient.