Lecture 10 - Knee and thigh rehab Flashcards
Commonly follows the movement of the foot and hip
The knee
Common MOI for traumatic injuries (2)
Valgus and rotational forces
What leads to insidious onset of injuries of the knee? (2)
Poor biomechanics and control of hip/pelvis
Phase 1 of overall rehab of knee injuries
Focus on restoration of ROM, pain modulation, inflammatory control, modification of activities, and gait training
Phase 2 of overall rehab of knee injuries
Gaining full ROM
Demonstration of normal gait pattern
Basic to advanced strengthening and flexibility
Appropriate CV conditioning
Proprioception retraining
Phase 3 of overall rehab of knee injuries
Functional return to prior activity level
Sport/occupational specific progression
Grade 1 and 2 of MCL sprain typically treated with ____
Conservative treatment
Grade 1 MCL sprain time to RTP
avg 10.6 days
Grade 2 MCL sprain time to RTP
avg 19.5 days
Chances of re-injury with a grade 3 MCL sprain
78%
Strengthen what with a MCL sprain?
Hamstrings and quads
CKC asap (avoiding valgus forces)
What treatment of hip/pelvis control to avoid non-contact knee valgus?
Hip extension, adduction, abduction, external rotators, core strength
Important consideration for ACL sprain rehab (conservative)
Full range OKC knee extension should be avoided before 6-9 months following ACL surgery
ACL sprain - OKC extension at a low load are safe and safer to use from ___ to ___ degrees of knee flexion ROM
90 to 40
ACL sprain - high loads from ___ to ___ degrees of knee flexion can be harmful (can do full ROM of KE)
40 to 0
ACL sprain - from ___ knee flexion (“full KE’’) to __ knee flexion, avoid OKC with high loads
0 to 40
3 important things in ACL sprain rehab (conservative)
- terminal knee extension ROM (hard to get back)
- Hamstring strengthening
- CKC = less shear forces (more proprioceptive feedback = add to rehab program)
T or F: surgery is absolutely required if an athlete wants to return to sports with cutting after an ACL sprain?
TRUE
Does not often require surgery due to its MOI
PCL sprain
For meniscus tears, what is included in the 3-6 months of conservative treatment?
Quad strengthening, hamstring strengthening, activity modification, unloader bracing, NSAIDs, and neuromuscular retraining
Purpose of the unloader brace
Puts pressure on the outside of the knee, to open the space to decrease the irritation
Kinematics of IT band friction syndrome
Greater hip adduction, greater contralateral pelvic drop
4 things to do in IT band friction syndrome
- Decrease training load, running speed, hill work
- Stretch the lateral chain (3x a day)
- Strengthening of the gluteus medius
- Possible change in running shoes
Patellar tendinopathy rehab, what to avoid in activity modification?
Avoid jumping and implement stretching in early part of disease
Do we use eccentric exercises in patellar tendinopathy, why?
YES, load on patellar tendon can be maximized
Type of brace for patellar tendinopathy
Patellar strap
Kinematics of patellar tendinopathy
Peak hip adduction and ankle eversion were higher in runners and tibial IR/ER was lower with PT compared to control group
Kinematics of PFPS
Excessive IR of femur increase stress on patellofemoral joint, excessive pronation
For what injury is the balance between vastus medialis and vastus lateralis is important?
PFPS rehab
PFPS - in long run, ___ exercises promoting co-contraction of HS and quads has been shown to be superior
OKC
PFPS, strengthen what?
Isolated strengthening of quadriceps (both in OKC and CKC)
2 predisposing factors to hamstring strain
Strength and control of the lumbopelvic structures + quadriceps tightness
Type of strengthening for hamstring strain?
Eccentric strength
___ and __ shown to be superior to standard stretch and strengthening in hamstring strain rehab
Trunk stabilization and agility
Why is a hamstring strain rehab so long?
Because athlete RTP too soon (use taping, bracing, until end of season, play with pain)
and because it takes time to change the postural motions that causes it (ex: anterior pelvic tilt)
Typical muscle of quadriceps that his strained
Rectus femoris
What exercises are targeted for rehab of quad strain? (4)
Stretching, strengthening, proprioceptive, and functional training exercises
Complication of quad strains
Myositis ossificans
What to do in the first 24-48h with a quad contusion?
Stretching
Kinematics of patellar dislocation
Patellar/femur structure, medial and lateral retinaculum, valgus forces on knee
Can you use taping for patellar dislocation?
YES
Goal of patellar dislocation rehab (general)
Decrease swelling
Promote VMO and gluteal activity
What to use for ROM of the knee in early rehab of patellar dislocation?
Bike
Patellar dislocation - literature is leaning towards ___ more effective than __ strengthening
more CKC than OKC
Patellar dislocation - common to see knee lock/unlock at 20-30d, what to do to correct? (3)
Mini squats
VMO and VL timing emphasis
Optimal lower body alignement re-training
Excellent exercise for gaining ROM
Exercise bike (pendulum = full revolutions)
