Corrective Strategies for Knee Impairments

Question 1

Learning Objectives

Answer 1

Upon completion of this chapter, you will be able to:

• Understand basic functional anatomy for the knee complex.
• Understand the mechanisms for common knee injuries.
• Determine common risk factors that can lead to knee injuries.
• Incorporate a systematic assessment and corrective exercise

strategy for knee impairments.

Question 2

INTRODUCTION

Answer 2

Lower-extremity injuries account for more than 50% of injuries in college (1) and high school athletes (2), and among lower-extremity injuries, the knee is one of the most commonly injured regions of the body. Researchers have estimated health-care costs to be approximately $2.5 billion annually for anterior cruciate ligament (ACL) injuries (3). To prevent these injuries from occurring and allow individuals to maintain healthy and physically active lifestyles, it is important to understand the anatomy, causes, and most appropriate corrective exercise strategies for prevention
and management. This chapter will review each of these components as they relate to the knee.

Question 3

Review of Knee Functional Anatomy

Answer 3

The knee is a part of a kinetic chain that is greatly affected by the linked segments from the proximal and distal joints. The foot and ankle and the lumbopelvic-hip complex(LPHC) play a major role in knee impairment, as the structures that help to form the ankle and hip joints make up the knee joint. This region is a prime example of how alterations in other joints within the human movement system can dramatically affect the movement and increase the stress and injury capacity of another joint, which leads to knee impairments.

Question 4

Knee Functional Anatomy

tibiofemoral joint

Answer 4

tibia and femur

Question 5

The patellofemoral joint

Answer 5

the patella and femur

Question 6

The iliofemoral joint

Answer 6

Proximally, the femur and the pelvis

Question 7

Common Knee
Injuries

and
Associated Movement
Deficiencies

Answer 7

Patellar Tendinopathy
(Jumper’s Knee)

Patellar tendinopathy is a common overuse injury Figure 13. 4. It occurs when an individual places repeated stress on the patellar tendon.

Question 8

Key Muscles Associated With the Knee

Answer 8

• Gastrocnemius/soleus
• Adductor complex
• Medial and lateral hamstring complex
• Tensor fascia latae/IT-band
• Quadriceps
• Gluteus medius and maximus

Question 9

Patellar tendinopathy

Answer 9

Aan injury common with, but not limited to, athletes, particularly those participating in jumping sports such as basketball, volleyball (7 – 10), or high or long jumping.

Question 10

Risk factors for
patellar tendinopathy include the following

Answer 10

• Knee valgus and varus
• An increased Q-angle
• Poor quadriceps and hamstring
• complex flexibility
• Poor eccentric deceleration
• capabilities
• Overtraining and playing on
• hard surfaces

Question 11

Common Knee
Injuries and
Associated Movement Deficiencies

Iliotibial Band
(IT-Band) Syndrome
(Runner’s Knee)

Answer 11

(Runner’s Knee) IT-band syndrome is the result of
inflammation and irritation of the distal portion of the iliotibial tendon as it
rubs against the lateral femoral condyle

Figure 13. 5, or less commonly,the greater trochanter of the hip, causing greater trochanteric bursitis.

Question 12

Iliotibial Band
(IT-Band) Syndrome
(Runner’s Knee)

Cont.

Answer 12

The injury is most commonly reported in runners as a result of abnormal gait or running biomechanics. although other athletes (e.g., cyclists, tennis players) also may be affected. Weakness of muscle groups in the kinetic chain may also result in the development of IT-band syndrome

Weakness in the hip abductor muscles, such as the gluteus medius, may result
in synergistic dominance of the TFL (increasing frontal plane instability). This, in turn, may lead to increased tension of the IT-band and thus increased friction on the tissue, with inflammation being the end result.

Question 13

Patellofemoral Syndrome

Answer 13

One of the most commonly accepted causes of patellofemoral syndrome (PFS) is abnormal tracking of the patella within the femoral trochlea

Question 14

Anterior Cruciate Ligament
(ACL) Injury

Answer 14

Beyond the common injuries indicated that are more chronic in onset, recent studies also indicate that altered lower-extremity neuromusculoskeletal control imbalances can increase the risk of acute injures such as ACL ruptures

Specifically, peak landing forces were significantly predicted by valgus torques at the knee, women demonstrated decreased relative knee flexor torque during landing compared with men, and women had greater side-to-side differences in normalized hamstring complex peak torque

Question 15

SYSTEMATIC PROCESS TO DETERMINE KNEE IMPAIRMENTS

KNEE ASSESSMENT PROCESS AND OBSERVATIONS

Answer 15

See chart

Question 16

SYSTEMATIC CORRECTIVE EXERCISE STRATEGIES FOR
KNEE IMPAIRMENTS

Answer 16

Neuromusculoskeletal control imbalances are often evident in adolescent female athletes, which include ligament dominance (decreased lower-extremity frontal plane stability), quadriceps dominance (decreased relative strength or recruitment of the posterior chain musculature), and leg dominance (limb-to-limb asymmetries in neuromusculoskeletal control or muscle recruitment)

Question 17

SAMPLE CORRECTIVE EXERCISE PROGRAM FOR KNEE IMPAIRMENT

Answer 17

Question 18

SUMMARY

Answer 18

Lower-extremity injuries account for a majority of the total injuries in both college and high school athletes. Among lower-extremity injuries, the knee is one of the most commonly injured regions of the body. The knee is a part of a kinetic chain that is impacted by the linked segments from the proximal and distal joints. The described The integrated assessment process uses four primary assessments of the linked segments from the proximal and distal joints, which include static posture, movement assessments, goniometric measurements, and manual muscle testing. On the basis of the collective information obtained from these assessments, neuromusculoskeletal control deficits are identified for targeted treatments. The use of the outlined corrective exercise strategies for knee impairments provides health and fitness professionals with a systematic approach that can ultimately reduce the risk of knee and lower-extremity injuries while improving performance measures.