Sports Injuries Of The Knee And Shoulder Flashcards
What is the number 1 contributor to sports injuries?
Training load increase
Volume increase
Dramatic change within a few weeks
What are the contributors to sports injuries?
Training increase Structure Mechanics Tissue quality Physiology/ nutrition Psychosocial
True or false; you cannot underload an injury
False; underload causes it to get weaker.
Cartilage, muscles, and ligaments need forces applied to it in a progressive manner to allow adaptation.
What are the 3 steps of change to occur at the muscle?
Stimulus
Rest period
Adaptation
What contributes to elevated load?
Overall volume Rapid change in volume/ level/ intensity Competition congestion Psychological stress Lack of sleep/ travel demands Inadequate nutrition and hydration
What is the most common type of knee injury?
Ligament injury (and of that, its ACL)
What are the anatomical risk factors associated with an ACL tear?
• Age and gender —< 12 males = females — 12 females >>> males •Knee Joint Geometry •Pelvic Width •Ligamentous Laxity •Hormonal •Femur/tibia lever length
What are the modifiable risk factors associated with an ACL tear?
Dynamic valgus alignment
Quad dominance
Trunk dominance
Limb dominance
What is the correct return to sport progression?
Closed environment agility training Closed environment agilities with equipment Open environment no opposing player Open environment with opposing player Modified practice Modified games Full Competition
True or false; isolated PCL tears can be treated non-operatively
True
Why is quad strengthening so important in the treatment of PCL tears?
Decreases posterior translation of tibia on the femur
What are the PCL rehab guidelines?
- PWB/WBAT with use of locked brace until quad control (~4 weeks)
- Progressive ROM (0-90 for 4 weeks)
- Focus on quad control and stability
- No isolated HS strengthening ~12 weeks
- Criterion based progression
- Expected Return > 6 months
What is in the posterior lateral corner of the knee?
LCL Popliteus Hamstrings IT band Popliteal fibular ligament
True or false; the MCL has a rich blood supply and can heal itself
True
What is the return to sport protocol for an MCL tear?
Progressive RTP criteria:
• Full, pain-free ROM
• No laxity/instability on clinical examination
• 90% strength of contralateral side.
How do you manage an acute MCL tear rehab?
• Protect against valgus and tibia rotation —Use of brace • Control effusion/swelling • Early and progressive ROM • Early quad activation • Normalize gait
What is the exercise progression of an MCL tear in the restorative phase?
- Sagittal plane—> frontal plane
- Bilateral—> unilateral
- Leg Press/ wall squats/ Mini squats
- Balance/Perturbation training
- Side stepping and cariocas
- Toward uninvolved harder
How do you manage ITB friction syndrome?
Manage pain and inflammation
Address individual impairments
What are some things you’d expect to see during the reactive phase of a tendinopathy?
Pain
Decreased function
Water in tendon
But it is a reversible process and the tendon is still normal
What is the cause of patella tendinopathy?
Increased tensile loads placed on patella tendon
What are some methods of managing tendinopathy?
Tendon unloading
Normalize ROM
Promote tendon healing/ balance
Promote strength/ balance above and below
Challenge in functionally progressive manner
Pt has the following:
Decreased medial patella tilt to horizontal
Decreased medial glide of patella Lateral knee tightness
What’s the diagnosis?
Patella lateral compression
Pt has the following:
Hypermobile patella (hypoplastic groove) Quad weakness
What’s the diagnosis?
Patella instability
Pt has the following:
Movement dysfunction
Hip Weakness
Ankle ROM limitations
What’s the diagnosis?
Biomechanical dysfunction
Pt has the following:
History of trauma Swelling/external bruising
What is the diagnosis?
Direct patella trauma
Pt has the following:
Palpation along joint line Joint effusion
Taping with asterisk sign
What is the diagnosis?
Soft tissue lesions
Pt has the following:
Training errors/change in activity
Tenderness along tendon
STTT
What is the diagnosis?
Overuse syndromes
What are the treatment guidelines for patella compressions?
- STM (distal and prox)
- Patella mobility
- Patella taping
- Muscle stretching
What are the treatment guidelines for patellar instability?
• Bracing (static stability) • Dynamic stability of
kinetic chain
What are the treatment guidelines for a biomechanical dysfunction?
- Hip and Ankle
- LLI
- Orthoses (temporary)
What are the general treatment guidelines for direct patella traumas?
- ROM activities
- Modalities (pain/ effusion) control
- Gradual loading
What are the treatment guidelines for soft tissue lesions?
• Limit painful activities in
acute phases
• Restore Biomechanics
• Taping often helpful
Who is at risk for shoulder injuries?
Overhead sports
Collision sports
Risk of falls
What are the phases of a throw?
Wind up Early cocking phase Late cocking phase Acceleration phase Deceleration phase Deceleration and follow through phase
During the late cocking phase involves stress on the ______ shoulder and force on ______ rotator cuff to control it.
Stress on anterior shoulder
Force on posterior cuff
During the deceleration phase, ________ on the posterior cuff controls internal rotation
Traction
During the throwing progression, when is a SLAP lesion most likely to occur?
Late cocking phase
