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physio led assessment & treatment > Musculoskeletal (Knee) > Flashcards

Musculoskeletal (Knee) Flashcards

1
Q

PFP Pathophysiology

A

Patella mal tracking and patella trochlear groove variability can result in PFJ stress, can be the hereditary irregular shape of the bones, possibly related to imbalances of forces at the knee

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2
Q

PFP Aetiology

A
  • Multifactorial = structure, biomechanics, load, volume and intensity.
  • Primary culprit suspected to be subcondral bone due to dense nociceptive fields.
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3
Q

PFP Prognosis

A

50% of people will report symptoms beyond 5 years of diagnosis (Lack et al., 2018)

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4
Q

PFP Management

A

exercise, movement retraining and load management (Lack et al., 2018). Hip strengthening, knee strengthening, orthotics, neoprene sleeve, taping

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5
Q

Patella Tendinopathy Pathophysiology

A

Tendon microtrauma from overloading of the tissue leading to alterations at the cellular level which weaken the mechanical properties

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6
Q

Patella Tendinopathy Aetiology

A

Chronic repetitive tendon overload is the most common theory, another theory is inferior patellar pole impingement though this has not been proven biomechanically

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7
Q

Patella Tendinopathy Prognosis

A

Can take several months or longer (Malliaras et al., 2015), after 12 months only 46% of athletes were pain-free following an eccentric strength training program (Bahr et al., 2014)

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8
Q

Patella Tendinopathy Management

A

Activity management, and eccentric loading should be the first line Rx for PT (Challoumas et al., 2021).

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9
Q

Management of PFP

A

LACK ET AL., 2018 (SR)
Exercise therapy (training the hip and thigh muscles)
* Proximally targeted exercise when added to knee targeted exercise may improve symptoms
* Exercise can improve function the short, medium and long term of PFP
* Proximally CKC targeted exercise may improve pain and function to a greater extent than knee targeted exercise

Secondary / Supplementary
* Movement/Run retraining
* Taping
* Foot Orthoses
* Neoprene sleeves
* Education, have been shown to be effective in the management and Rx of PFP

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10
Q

Management of PT

A

CHALLOUMAS ET AL., 2021 (MA)
* Eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy
* Shockwave provides limited clinical benefits

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11
Q

What is the objective assessment proccess for the knee?

Clinical Physio Flashcard

A
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12
Q

What are the red flags and special Q’s for knee?

Clinical Physio Flashcard

A
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13
Q

What were the Key findings of Neal et al (2022) regarding the treatment of PFP?

A
  1. Non-surgicall treatments are appropiate for people with PFP
  2. Knee exercise therapy, combined interventions, foot orthoses, and knee focused manual therapy all showed primary efficacy when compared to a “wait and see approach”
  3. Combined hip and knee with perineural injection and combined intervetntions each showed increased efficacy when compared to knee-focussed exercise therapy alone
  4. Only foot orthoses and hip-and- knee-targeted exercise therapy combined with hyaluronic acid injection have been adequately tested beyond a short-term follow-up.
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14
Q

What are the six phases of ACL rehabilitation (with reference)?

A
  • Preop Phase: Injury recovery & readiness for surgery
  • Phase 1: Recovery from surgery
  • Phase 2: Strength & neuromuscular control
  • Phase 3: Running, agility, and landings
  • Phase 4: Return to sport
  • Phase 5: Prevention of re-injury

(Melbourn ACL Rehabilitation Protocol)

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15
Q

What are the five principals of ACL rehabilitation.

A
  1. **Get the knee straight early **(within the first 2-3 weeks both post injury and post surgery), and keep it straight. Flexion can progress gradually.
  2. Use knee pain and knee swelling as a guide. If either or both are increasing, the knee isn’t tolerating what you’re doing to it.
  3. Technique is everything. Compensation patterns develop after an ACL tear, so focusing on correct muscle and movement/biomechanical patterns is paramount.
  4. Build high impact forces gradually. The articular structures in the knee joint will take time to adapt to a resumption of running, jumping and landing.
  5. Complete your ACL rehabilitation. Once people are back running with no knee pain it’s easy to think that it’s all done. But the last 1/3 of the protocol is the most important – to help reduce the chance of re-injury, increase the chance of a successful return to sport, and possibly to reduce the likelihood of osteoarthritis down the track.
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16
Q

Regarding ACL rehabilitation, what are the primary goals of the pre-op phase?

A
  • Eliminate swelling
  • Regain full range of motion
  • Regain 90% strength in the quads and hamstring compared with the other side
17
Q

Regarding ACL rehabilitation, what are the primary goals of the recovery from operation phase?

A
  • Get the knee straight (fullextension)
  • Settle the swelling down to ‘mild’
  • Get the quadriceps firing again
18
Q

Regarding ACL rehabilitation, what are the primary goals of the strength and neuromuscular control phase?

A
  • Regain most of your single leg balance
  • Regain most of your muscle strength
  • Single leg squat with good technique and alignment
19
Q

Regarding ACL rehabilitation, what are the primary goals of the Running, Agility and Landings phase?

A
  • Attain excellent hopping performance (technique, distances, & endurance)
  • Progress successfully through an agility program and modified game play
  • Regain full strength and balance
20
Q

Regarding ACL rehabilitation, what are the primary goals of the Return to sport phase?

A
  • Successful completion of the Melbourne Return to Sport Score (>95)
  • The athlete is comfortable, confident, and eagerto return to sport, as measured by the ACL-RSI and IKDC
  • An ACL injury prevention program is discussed, implemented, and continued whilst the athlete is participating in sport. To lower the risk of future injury, evidence supports that injury prevention programs are performed at least 15mins prior to each training session and game.
21
Q

Regarding ACL rehabilitation, what are the key components of the re-injury prevention phase?

A
  • Plyometric, balance, and strengthening exercises
  • That the program must be performed for at least 10 mins before every training session and game
  • That the program is ongoing
22
Q

What are the five phases of conservative meniscal injury management and what is the principal aim of each?

A
  • Phase 1: Regain knee extension, reduce effusion, aim full weight bearing, early
  • focus on Quads strengthening
  • Phase 2: Progress knee flexion towards full range of movement, and focus on gaining strength in Quads, Hamstrings and Gluts
  • Phase 3: Focus on higher level quadriceps and hamstrings, aiming for 85% strength in injured leg, still mainly straight line activity
  • Phase 4: Aim for 90% strength in injured leg, begin multi-directional activity and controllable plyometrics
  • Phase 5: Aim for 95% strength in injured leg, with clearer twisting and turning drills, higher level single leg plyometrics and return to sport drills
23
Q

What are the recommendations of Sherman et al, 2020 regarding post-operative meniscal management?

A

Phase 1:
* Ensure pain is under control and steps to reduce effusion
* Requires focus on regaining full knee extension and quadriceps activity Aim for 120° flexion by 4 weeks
* Blood flow restriction training may be useful for restricted loading Progress to Phase 2 when:
* WBAT, Normalised Gait, Minimal Effusion, Full Active Extension
Phase 2:
* Goal to restore > 70% strength in operated leg (Quads and Hamstrings)
* Aim for patient to be able to
* Squat their bodyweight to 75° with no pain or shifting of weight Single leg balance for 30 seconds with no difficulty
* Ascend and descend stairs with no pain or shifting of weight Regain full knee flexion
* Low impact CVR exercise could be a feature
Phase 3:
* Goal to restore > 80% strength in operated leg and gentle re-introduction to demand-specific athletic movement
* Strength training with higher increases in load and range of movement Multi-plane balance and stability testing
* May introduce straight line plyometrics with predictable changes in direction (skipping, shuffling, jogging, shallow double leg jump and land)
Phase 4:
* Goal to restore > 90% strength in operated leg and gentle re-introduction to demand-specific athletic movement
* Significant focus on strength and power and sports-specific training
* Must utilise RTS Criteria such as isokinetic testing, Y balance test, absence of effusion, battery of hop tests

physio led assessment & treatment (21 decks)

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