Therapeutic Exercise for Knee

Question 1

Gait: Initial Contact

Answer 1

Objective: Start stance w/ heel rocker; impact deceleration

• Hip Flexed 20 degrees
• Knee Ext 5 degrees
• Hip extensors active in prep for LR
• Quads contract to prepare for loading response and hamstrings counteract the brief ext torque

Question 2

Gait: Loading Response

Answer 2

Objective: Shock absorption

• Hip Flex 20 degrees
• Knee flex 20 degrees
• Glut max, hamstrings, and adductor mag contract due to flexion torque
• glut med, glut min and TFL contract to stabilize in frontal plane

Question 3

Gait: Midstance

Answer 3

Objective: Progress over stationary foot; limb/trunk stability

• Hip in neutral 0 degrees
• Knee Ext 0-5 degrees
• No muscle activity in sagittal plane
• Pelvis stabilized in frontal plane by the hip abductors(glut med)

Question 4

Gait: Terminal Stance

Answer 4

Objectives: progress body beyond the supporting foot; limb and trunk stability

• Hip Ext 20 degrees
• Knee Ext 0-5 degrees
• TFL fires to restrain hyperextension of hip
• Knee stabilized by calf and bicep femurs

Question 5

Gait: Pre-Swing

Answer 5

Objectives: postion limb for swing phase; accelerate progression

• Hip neutral: 0-5 degrees Ext
• Knee flexed 40 degrees
• Limb advancement begins
• Knee flexes to prepare for toe clearance (passively due to rapid recoil of stance limb with weight acceptance on contralateral limb)

Question 6

Swing Phases: Initial swing

Answer 6

Objectives: foot clearance; advancing limb forward

• Hip flexed 15 degrees
• Knee flexed 60 degrees
• Peak activity = gracilis and sartorius and biceps femoris are concentrically active

Question 7

Swing Phases: Mid-Swing

Answer 7

Objectives: advancing limb; foot clearance

• Hip flex 25 degrees
• Knee flex 25 degrees
• Iliacus, gracilis and sartorius stop firing late
• Hamstrings fire eccentrically late MS to control hip flexion
• Momentum created by swinging limb helps carry body past the stance limb

Question 8

Swing Phases: Terminal Swing

Answer 8

Objectives: complete limb advancement; prepare for IC

• Hip flexed 20 degrees
• Knee ext 0-5 degrees
• Glut max and add magnus prepare to stabilize at IC
• Quads contract to ensure full ext

Question 9

Knee PROM: Extension

Answer 9

1. Pad under heel
2. Prone leg hangs w/ pad under quad
3. Towel stretch
4. Elite seat: pulley system
5. Retrowalking
6. Stationary bike (seat adjustment)

Question 10

Knee ROM: Flexion

Answer 10

1. Heel slides (w/ towel)
2. Wall slides
3. AAROM on chair with opposite foot
4. Stationary bike (seat adjustment)