Knee Flashcards
Examples of Knee Pathology
- PFPS
- Patellar Tendinopathy
- ITB Syndrome
- Knee OA
- ACL
PFPS
- patellofemoral pain syndrome
- most common complaint in runners
- repetitive overload
PFPS Influences
- local (mal-tracking)
- proximal
- distal
PFPS: Local Influence
- mal patellar tracking
- patellar tilt that compresses lateral patella
- delayed activation of VMO
PFPS Treatment
Local
- VMO/biofeedback
- Straight leg raising-hip adductors (leg in ER)
- limited squatting–>full squat
- patellar taping (short term)
- stretch IT band
Normal Patellar Tracking
- with knee in flexion patella is lateral
- as knee extends patella tracks medial then laterally
- should not tilt
PFPS:
Proximal Influence
- hip affects knee
- dynamic Q-Angle
- weak abd/ER Mm allowing femur to IR and increase Q-angle–>more stress on patella
PFPS:
Distal Influence
-Overpronation of the foot causes tibial/femur IR and knee valgus–>increased stress on patella
Foot Orthotics with PFPS
-has some research to support decreased pain
Tendinitis
- inflmmatory
- warm to touch
- Ice, NSAIDs
Tendinosis
- Collagen degeneration
- chronic
- exercise, (eccentrics)
Mechanism of patellar tendinopathy
- weak quads
- overuse of tendon (dominant quads, glut max weak)
Quad dominant
-in squat knees go way past feet
Glut max dominant
-in squat, sit back with knees behind toes
Work quad more on:
-down sloped wedge
work glut max more on:
-flat surface
Plyometrics:
- forward hops
- bounding
- step hops
cho-pat strap
- brace for knee (PFPS)
- decrease tendon strain
ITB Syndrome
- Iliotibial band syndrome
- pain 1-2” above joint line, lateral side
- 2nd cause of knee pain
Nobles Compression Test
-ITB Syndrome test
Function of ITB
-decelerate IR or tibia
Insertion of ITB
- patella
- Gerdy’s tubercle
- Fibular head
Impingement Zone
- 20-30* flexion
- ITB more taut and causes pain on fat pad under ITB
Biomechanical factors of ITB Syndrome
- prominent LFC (lateral femoral condyle)
- weak hip abductors
- ITB tightness
- Genu varum
Treatment for ITB Syndrome
- strengthen (glud med, hip ER)
- joint mob (sup tib-fib)
- Foam Roller
- cho-pat bracing
- Surgery: cut ITB and shave down lateral epicondyle
ITB Syndrome & Running
- avoid running down hill
- avoid banked surface (valgus knee)
Diagnosing OA
- knee pain plus 3 of following:
- -age>50
- -AM stiffness <30 min
- -Crepitus
- -bony tenderness
- -no palpable warmth
- -osteophytes on x-ray
Risk Factors of OA
- age
- female
- obesity
- previous injury (ACL, Meniscus)
- Mm Weakness
Stage I for OA Rehab
- joint mobs (distraction, ant/pos, rotational)
- strengthen around knee
- weight reduction
- canes, unloader braces, orthotic wedging
TKA Rehab
- Quad strengthening
- Eccentric Stepper
- NMES with Quad Ex’s
Eccentric Stepper
- 5-20 min sessions
- 4 weeks
- increase intensity over 12weeks
NMES Quads
- 2-3 weeks post surgery
- 3x/week
- 6 weeks
- open and closed chain
ACL Prevention:
3 Phases
- Technique Development
- Fundamental
- Performance
ACL Prevention Program
- 15-25 min warm up routine
- 3x/week
- warm up, stretch, strengthen, plyometrics, agility
Stage II Knee OA Rehab
Hip strengthening
Stage III Knee OA Rehab
Aerobic Exercise
Treatment of Knee OA
- manual therapy
- open vs closed chain ex’s
- weight loss
- AD (cane, unloader brace, orthotic wedging)
- cycling
- aquatics
Medical Management of Knee OA
-total joint arthroplasty (TKA)
UCA
- unicompartmental arthroplasty
- only replace the side that you need
Activities Allowed After TKA
- low impact aerobics
- stationary cycling
- bowling
- golf
- dancing
- horseback riding
- swimming
- walking
Activities Allowed if You’ve Done them before (after TKA)
- road cycling
- canoeing
- hiking
- rowing
- cross-country skiing
- nordic track skiing
- speed walking
- tennis
- ice skating
Activities Not Recommended after TKA
- racquetball/squash/handball
- soccer
- single tennis
- volleyball
- basketball
- jogging
