Knee Flashcards
knee extension arthrokinematics
anterior roll and glide
knee flexion arthrokinematics
posterior roll and glide
which condyle is bigger… medial or lateral
medial (its also more curved)
meniscus special tests
mcmurrays, appleys, thessalys
males with knee pain tend to have weaker ___ while females have weaker _____
quads
hips
is ther-ex well supported to manage TKA and sprains? what about meniscal injuries
yes
A for TKA/sprain
B for meniscal and articular cartilage injuries
T or F: therex is well supported for patellofemoral pain and OA
T
what is the primary NSAID for knee OA
tramadol
when you make IC, you load the _____ compartment and the knee is in
medial
varus
when you go into midstance, you load the ____ compartment and the knee is in
lateral
valgus
how can you control valgus at the knee
strengthen the hips
are closed or open chain exercises more functional for the knee
closed
does closed or open chain help with proprioception
open
move pt’s leg into a position with their eyes closed. they suddenly let go and have them hold it there
in the late phase of rehab, you should be working in ____ chain
closed
T or F: early weight bearing is usually best. why are why not
T: it facilitates the quad muscles, reduces atrophy, and assists with knee motion
what do postural muscles do in the presence of pain
shorten and tighten
LE postural muscles
hip adductors
hamstrings
hip flexors
rectus femoris
gastroc
what do phasic muscles do in the presence of pain
lengthen and atrophy
LE phasic muscles
glutes
vastus muscles
ankle DFs
what do you need before speed and power training
a good strength base
nordic exercise
eccentric exercise for hamstrings
- hold feet in kneeling and have pt slowly lower themselves down
the patella makes contact at ____ degrees of knee flexion
20
T or F: with patellofemoral arthritis you can start with a shallow squat for strengthening
T: because the patella doesn’t make contact until 20 degrees
*but w/ tibiofemoral you may want to stay away from standing initially
when you make initial contact your foot is ______ and during loading it is ________
supinated
pronated
4 main goals for knee rehab
1 - obtain full ext
2 - muscle activation, esp quad
3 - reduce effusion
4 - obtain knee flexion
5 phases of knee rehab post surgery
1 - intro/pre-op
2 - unloaded activities
3 - CKC
4 - strength training
5 - return to activity
T or F: pre-op ROM is a major indicator of post-op ROM
T
*best to go into surgery with full ROM and strength
arthrofibrosis
stiffness in the joint
T or F: delaying surgery delays return to sport
F: b/c going into surgery too early (w/o good strength and ROM) has worse outcomes
when does unloaded activities phase begin
immediately after surgery
what plane do you focus on during unloaded activities phase and why
sagittal plane because you want to avoid shear
goals during unloaded activities
protect healing structures
control pain and swelling
ROM
patellar mobility
muscle activation
is knee flexion or extension more important
extension, this is what you should worry about first
treatment options during unloaded activities phase
isometrics
patellar mobs
prom/aarom/arom
soft tissue
flexibility
what muscles do you want to stretch post knee surgery
gastroc
hamstrings
quad set
pt activates quad, patella moves, sustain patellar movement, extent the knee against gravity, hyperextension
how do you progress a quad set
straight leg raise w/o quad lag
complications are not common w/ arthroscopic knee surgeries but what is the most common complication
infection
what is the goal during the closed kinetic chain phase
full ROM
return to ADLs
muscular endurance
proprioception
what phase do you really start to work on knee flexion ROM
closed kinetic chain
what might quad avoidance look like during gait
- knee hyperextension
- decreased stance time
- limp through midstance b/c they don’t have the quad strength for full knee extension
once you are past _____ degrees of flexion, stress on patellofemoral joint does not increase significantly
70
how do you know how deep to have your pt squat
listen to your pt, stay in pain free range. also depends on kind of surgery they had
T or F: ACL deficiency can cause reorganization of the CNS
T: this is why you should work on proprioception
what are the goals during strength training phase
normalize muscle strength
speed of movement
agility/proprioception
what phase can you start adding more weight and plyometrics
strength training phase
why is it important to work on hamstring strength after knee surgery
they need to be strong to counteract anterior pull of quad
how do you activate the glutes more during a squat
widen the stance
which recruits more glute max… barbell hip thrust or back squats? what are two other exercises that are good for the glutes
barbell hip thrusts
side plants, single leg deadlift
4 hop tests
1 hop for distance
crossover hop
triple hop
6m timed hop
both traditional _______ training and ______ training need to be incorporated into a comprehensive rehab program
strength
neuromuscular
T or F: after ACLR males and females both demonstrate decreased vertical ground reaction force on the ACLR side
T
most common knee position for ACL injury
near extension
often tibial IR and valgus
most common knee position for PCLinjury
deep flexion
where is the thickest articular cartilage in the body
back of patella
pronation is associated with tibial ______
IR
how does the meniscus move during open chain knee extension
it moves anteriorly
same direction as the tibia
functional progression for return to play
- sport specific drills
- position specific drills
- scrimmage
- games
3 major factors in post-op care
1 - surgeon and PT
2- patient
3 - biology
factors for post-op care relating to PT and surgeon
1 - correct dx
2 - correctly and gently performing surgery
3 - appropriate and careful rehab
factors for post-op care in the patient’s control
- ice the knee
- rest the knee
- protect knee during healing
- compliance with home instruction
factors for post-op care related to biology
- extent of pathology
- genetic efficiency of tissue healing
what does 5/0/140 mean in ROM documentation
5 degree hyperextension
140 degree flexion
what does 0/10/130 mean in ROM documentation
lack 10 degrees of extension
130 degrees of flexion
what are some PROM exercises to work on getting knee extension
prone hang
heel prop
towel pull
what are some PROM exercises to work on getting knee flexion
use the well leg to apply pressure to surgical
- supine passive flexion
- wall slide
- sitting knee flexion
it is best to do post glides in ____and ant glides in _____
flexion
extension
* take them to end range
which part of the capsule is tight in knee flexion? extension?
anterior
posterior
cues for SLR post knee surgery (proper sequencing)
- quad set
- lift leg
- lower leg
- relax quad
how to make a lunge more difficult
increase instability (foam, reaching activities, make sure to engage glute med)
