knee rehabilitation Flashcards
week 5
knee rehab
red flags to look for
- DVT
- acute exertional compartment syndrome
- infection
- tumor
overuse injuries - general guidelines
- rest
- ice
- improve mechanics
- strengthening
- hip/core stability
- activity modification
- proprioceptive training
medial tibial stress syndrome (MTSS)
what should be done during the rehab process?
all pulled from CPG
type of shin split
- strengthening/stretching lower leg
- arch support tapping
- arch strengthening (decrease pronation)
- massage for the muscles around shins
- orthotics or shoe inserts (OTC recommended)
- a pre-activity dynamic warm up regimen
- SL exercises, balance, squats, reaching, heel raises
- modified takeoff and landing techniques for jumping athletes
- modified leg and foot control during walking/running
- suggestions for footwear that provides better support
periostitis
what should be done during rehab process?
SUBACUTE:
- decrease running distance & intensity by 50%
- avoid running hills (esp down), uneven or very firm surfaces
- develop core stability (abds, glutes, hips)
- footwear, orthotics
- MT
- spliting/bracing
other treatments:
- extracorporeal shock wave thearpy
- injections
- acupuncture
- surgery
exertional compartment syndrome guidelines:
- week 0-3
- week 4-6
- week 6-8
- week 8-12+
osgood schlatter
rehab process
- self limiting may persist 2> years
- relative rest (no evidence that rest speeds recovery)
- protective knee pad to protect tibial tubercle from direct trauma
- hamstring stretching and quad sretching and strengthening - no evidence for injections or surgery
- resolution upon closure of apophysis
pain and swelling below the kneecap in growing adolescent, risk factors: Participation in sports that involve running and jumping, Growth spurt, and Male gender
sinding -arsen johansson (SLJ) syndrome
- general patellofemoral pain
- exercise: hip and knee targeted exercises
- patellar taping (short term maybe?)
- NO patellofemoral knee orthoses
- foot orthoses (short term 6 weeks)
- blood flow restriction plus high rep knee exercises
- NO dry needling
knee
tendinopathy/strain general guidelines
- relative rest
- progressive loading (HSRT)
- improved biomechanics
- hip.core stability
- motor control
- strengthening
- mobility
- maintain ROM
- return to activity w/ guidance
- tissue mobility
- monitor pain response
patellar or quadriceps tendinopathy:
rehabiliations stages and pression criteria
patellar tendon rupture
rehab
surgical reconstruction
- options for patellar graft
- semitendinosus/gracilis,central quadriceps tendon-patellar bone
post-op rehab
- follows post op rotocol for surgeon
conservatie management only for partial tera w/intact extensor mechanism and comorbidities making them at risk for surgical complications
quadriceps tendon rupture
rehab
surgical reconstruction
- suture anchors: smaller incision, shorter operative times
- patellar drill holes
- end to end sutures
post-op rehab:
- follows protocol from surgeon
- conservative managemetn only for partial tera with intact extensor mechanism
hamstring tendinopathy
stages:
4 of them
Stage 1:
load/reduce pain
- isometric hamstring lad w/out tendon compression
Stage 2:
load/Ok w/ slight pain
- isotonic hamstring load w/minimal hip flexion
stage 3:
strength, hypertrophy, functional progression
- isotonic exercises in positions of increased hip flexion (70-90°)
stage 4:
return to sport
energy storage loading
main rehab points to hit when working with hamstring strain
- progressive running programs
- agility
- trunk stability
- comprehensive impairemnt based treatment
- tissue mobilization to reduce adhesions to surrounding tissue
gastrocnemius tendinoapthy
rehab
NSAIDs NOT recommended within 24-72 hrs
- gentle stretching
- strengthening
- heel raises
- proprioceptive exercises
- weight-bearing/dorsiflexion delayed until pain decreases
first line is for all tendinopathies
popliteus strain
rehab
Bracing
knee ROM exercises
strengthening
- gastrocnemius
- hamstring
- quadriceps
- popliteus
static and dynamic proprioceptive training
agility
you are working in end ranges - screw home mechanism. hyperextension is not good for this
joint structure - rehab general guidelines
- post surgical managemetn based on protocols
- maintain ROM
- progressive strengthening
- progressive functional activity
- hip/core stability
- improve biomechanics
- quad/hamstring strengthening
- gait
- progressive functional activites
meniscus post surgical rehab
post surgical
- early progressive knee mobilization following surgery
- early PROM and AROM following surgery
- early progressive RTA
- exercise as part of in clinic supervised program after surgery
- ( quads, hamstrings)
NMES for quad strengthening
- faciliate quads w NMES
- normalize gait
- endurance activity w/ low impact
patellofemoral pain
rehab
patellar taping (short term maybe)
NO patellorfemoral knee orthoses
foot orthoses (only in short term ~6 weeks)
BFR restriction plus high rep knee exercises
NO dry needling
chondromalacia
surgical managment
osteoarthritis
rehab
osteochondritis dessicans
4 main rehab points
- limiting weight bearing activites
- modalities (Ice, heat, stim)
- bracing
- surgery
surgery is not great outcomes - trying to grow something that cant
rehab
Fractures:
patellar
- displacement < 4 mm and a step of <2mm
- extensor mechanism intact
- mobilization ~10th day
- bracing ~10° flexion
- not exceeding 90° for at least 45 days
- weight bearing in hinged joint locked in extension
- control radiographs
- progressive return to activity
rehab
fractures:
tibial plateau
non-weight bearing:
- often immobilized
- PROM
- CPM
partial weight bearing:
- AROM
- closed chain
- progressive weight bearing
full weight bearing:
- normalize gait
- functional activities
- proprioception
constant passive movement = CPM
mechanical
general guidlines - rehab
- ice
- relative rest
- ROM
- restore biomechanics
- progressive strengthening
- gait
- hip/core stability’
- motor control
mechanically what should be done during the rehab process for
patellar subluxation/dislocation
- progressive strengthening: OKC, CKC
(may avoaid isokinetic holds in initial phase) - NMES to faciliate quad activation
- full body dynamic movements
- reutrn to activity
mechanically what should be done during the rehab process for
fat pad syndrome
retore biomechanics of patellar tracking
- vastus medialis obliquus
- taping
- improving pelvic control
- glute strengthening
mobility of anterior hips/quads
injections
surgery
mechanically what should be done during the rehab process for
pre-patellar bursitis
- NSAIDS
- surgical:
remove thickened synovium - aspiration
mechanically what should be done during the rehab process for
plica syndrome
lower extremity stretching
knee extension strengthening
hamstrings/quads
NSAIDs
surgery
ligament injuries to knee
global dysfunction general guidelines- rehab
- activity modification
- progressive strengthening
- ROM
- mobility
- improve biomechanics
- hip/core stabilty
- functional activites
ligaments - knee - rehab
proximal tibiofibulr joint dysfunction - rehab keep points
- ankle motor control/strengthening
- hamstring strengthening
- tibiofibular mobilty
ligaments- knee- rehab
ITB syndrome
rehab
- soft tissue mobs
- taping
- BFR
- dry needling
- nerve mobs
- joint mobs
- balance
pes anserine bursitis/tendinopathy
rehab
- activity modification
avoid stairs - NSAIDs
- hamstring/calf stretching
- kinesio taping
go over nomograms
a higher likelhood ratio is good
What is plica syndrome?
A plica is a fold in the membrane that protects your knee joint. Most people have four folds in each knee. Sometimes the plica located in the middle of your knee becomes irritated. This is called plica syndrome and it’s characterized by pain, swelling and instability
