Knee Intervention

Question 1

Capsular restriction

Answer 1

Grade III and IV non-thrust manipulation
3-5 sets 3-5 minutes
Static stretching with creep or stress relaxation

Question 2

Flexibility

Answer 2

3-5 sets, 30-60 seconds each

Closer to 60 seconds is better for elderly patients

Question 3

Muscle performance and functional control

Answer 3

Consider co-contraction of quads and hamstrings
Goals:
-stability
-Improved biomechanics
-Coordination
-Endurance
-Motor Control
-Limit reflexive inhibition

Question 4

Exercise progression guidelines based on soreness

Answer 4

• If no soreness present from previous day, change one variable
• If soreness present from previous day goes away with warm up, stay at same level
• If soreness present from previous day doesnt go away regress to previous level

Question 5

Open Chain Exercises

Answer 5

Quad sets
Straight leg raises in 4 positions
Short arc quads
Full arc extensions
Hamstring curls

Question 6

Closed Chain exercises

Answer 6

Isometrics:
-Seated co-contractions
-Standing pertebations at the pelvis
Dynamic
-Unilateral knee extensions
-Standing SLR x 4
-Mini squats/squats
-Step ups/downs
-LE balance and Reach
-Wall slides
-Weight shift/Lunges
-Chair scooting

Question 7

Quad Weakness

Answer 7

Direct functional consequences
-Decreased knee excursion during stance phase
-Increases risk of fall in elderly
NMES shown effective to produce strength gains faster than volitional excercise alone when deficit >20%

Question 8

Eccentric Training

Answer 8

Greater changes in neural activation and muscle hypertrophy
-Good for tendonosis
-3 sets/ 15 reps, twice a week
-Significant improvements in strength and function in 12
weeks

Question 9

Balance and Reach testing

Answer 9

Named based off of direction in relation to the standing foot

Question 10

Closed chain excercises

Answer 10

Proprioception
-balance on firm surfaces
-EO/EC
-Perturbations
-Dynamic surface
Plyometrics
-Drills
-Sports/activity specific

Question 11

Motor Control

Answer 11

Training includes different platforms/surfaces, perturbations, amplitude, speed, multi-direction changes
-Start with focused challenge, progress to unexpected situations

Question 12

PFPS

Answer 12

Conservative management focus
-VMO strength
-Biofeedback
-LE flexibility
-Patellar taping
-Orthotics
Or look at the hip

Question 13

Important rehab considerations PFPS

Answer 13

Must work in pain free range
Mix of WB and NWB positions
-Quad sets
-SLRs
-Leg press/Total Gym
-Progress to function
-Improve core and hip strength and endurance
Local factors
-Pain can be caused by multiple tissues
Abnormal foot mechanics

Question 14

CPR for orthotics

Answer 14

If 3/4 factors present, 86% success rate

• > 25 y/o
• Height >5’5”
• VAS < 5.3
• Midfoot with difference WB to NWB >10.96mm

Question 15

Surgical considerations for PFPS

Answer 15

• Synovectomy
• Lateral retinacular release
• Distal realignment of tibial tubercle
• VMO imbrication (move it to more central/distal location
• MPFL repair

Question 16

PFPS pediatric considerations

Answer 16

Bipartite Patella

• two separate pieces of patella
• asymptomatic until direct trauma

Osgood Schlatter disease

Sinding-Larsen-Johnson syndrome
-Apophysitis and inferior pole of patella

Question 17

OA

Answer 17

Cyclic loading
-Bycicle; therapy ball; total gym
Strength training
-Quads; hamstrings; glutes
Flexibility
-Quads; hamstrings; hip flexors; hip rotators

Question 18

CPR hip mobilization for reduction in knee pain

Answer 18

2 or more present is 97% success rate

• Pain with ipsilateral hip distraction
• Ipsilateral knee flexion PROM <17
• Pain or paresthesia in ipsilateral hip or groin
• Ipsilateral anterior thigh pain