Knee repetitive tissue and stress strains

Question 1

what causes pes anserine bursitis?

Answer 1

repetiive motion or overuse

typically that causes resisted KF

Question 2

what is pes anserine bursitis?

Answer 2

inflammation of bursa between pes anserine group and MCL/medial tibia

Question 3

what are some symptoms of pes anserine bursitis?

Answer 3

• AROM and PROM knee extension may be painful
• resistive hamstring, sartorius or gracilis may be painful
• tightness of hamstrings and/or adductors

Question 4

what is the rehab for pes answering bursitis?

Answer 4

• control pain and inflammation
• STM
• gentle stretching
• avoid repetivei motion that is causing pain…
• can start strengthening once pain and swelling subside
• correct biomechanical factors such as muscle imbalances, excessive foot pronation, bike fit, shoes etc

Question 5

what are the clinical pearls for cyclists with pes answering bursitis?

Answer 5

• bike fit
• knee position on upstroke
• substantial change in trainng

Question 6

what are the clinical pearls for runners with pes answering bursitis?

Answer 6

• hip weakness
• hip ROM/joint mob
• shoes: type, age, orthotics
• runnign surface/change in trainign

Question 7

where/what is a bakers cycst?

Answer 7

posteromedial knee

• semimembranosus bursa
• communicates w knee joint
• not uncommon post srugery

if they have a bakers cyst and are not post op- check for intra articular pathology

Question 8

what is tendinitis?

Answer 8

• involve acute injures accompanied by inflammation:
• DO NOT utilize eccentric exercise
• pain during acitivty but resolves quickly afterwards

Question 9

what is tendinosis/opathy?

Answer 9

• chronic degeneration without inflammation
• accumulation of microscopic injuries that dont heal properly
• inflammation involved in initial stages of injury
• inability of tendon to heal perpetuates the pain and disability

Question 10

what is patellar tendinopathy?

Answer 10

• inflammation of patellar tendon
• commonly seen in athletes who jump to decelerate frqeuntly
• jumpers knee

Question 11

what are the 3 phases of patellar tendinopathy?

Answer 11

i: pain after activity (itis)
ii: pain during and after activity (becoming on osis)
iii: pain leading to functional disability/constant

Question 12

what can patellar tendinosis lead to?

Answer 12

tearing or rupture

Question 13

what is the rehab for -osis?

Answer 13

-heavy slow resistance program w goal of histological impact on tendon tissue
-progress to plyos and activity specific exercise
-cross friction massager once beyond inflamm phase
4-5x/week, 2-3 sets, 10-15 reps

Question 14

what is the rehab of itis?

Answer 14

-pain and inflammation control
-activity modification
-cho-pat straps or knee sleeves could help
-gentle stretching
-anti inflamm measures
2-4 weeks

Question 15

what is osgood-schlatters disease?

Answer 15

• traction of patellar tendon on immature bony anatomy
• develop pain and inflammation at tendon bone surface
• skeletally immaure (12-16 y/o)
• inflammation of tubercule w some fragmentation of growth plate
• do NOT do heavy slow resistnace

Question 16

what is the management of osgood-schlatters?

Answer 16

• rest/activity modification
• gentle stretching or extensor mechanism/quads
• correction of muscle imbalance and alignment issues
• modalities for pain/inflammation as indicated

Question 17

what causes IT band syndrome?

Answer 17

• friction of distal area across lateral femoral condyle

- COMPRESSIVE syndrome..tissue doesn’t move back and forth but the compressive force creates symptoms

Question 18

why does IT band syndrome occur?

Answer 18

compression created by combo of alignment and quad/TFL contraction timing during KF to extension

• overdeveloped lateral thigh muscles= increased forces and tension ITB and end up with compressive forces at the fat pad
• TFL tightness can be a cause
• many complain of popping or crepitus
• frequently seen in runners
• sharp, stabbing pain

fat pad compressed by: TFL, glute max, VL and lateral hams

Question 19

what is the rehab for ITB syndrom?

Answer 19

• correct muscle imbalances and foot mechanics
• stretching: TFL and VL
• patellar mobs (medial glide and tilt); prox tibiofibular manipulation
• STM
• iontophoresis
• NSAIDs/corticosteroid injection
• chronic cases may require surgery

Question 20

what is the most common thigh muslce strain?

Answer 20

hamstring for both primary injury and recurrence

Question 21

which strain is most common with high-speed sport/movement?

Answer 21

biceps femoris

Question 22

which strain is most common with extreme lengthening like gymnastics or dance?

Answer 22

semimembranosus

Question 23

what can be a complicating factor secondary to swelling and eventaul scar tissue near sciatic nerve?

Answer 23

neural tension

Question 24

which muscle of the quads is most commonly injured?

Answer 24

rectus fem

Question 25

which muscle of adductors most commonly injured?

Answer 25

add magnus

Question 26

what is the injury mechanisms of muscle strains?

Answer 26

quick explosive contraction often in transition from eccentric to concentric part of motion

Question 27

what is the best rehab method for muscle strains?

Answer 27

progressive return to functional activity and agaility and plyo based rehab programs

Question 28

what rehab may leave patient more susceptive to recurrence?

Answer 28

-progressive stretching and isolated eccentric loading rehab programs