Knee and Ankle Lectures

Question 1

What needs to be tested for integrity?

Answer 1

The relvant ligaments and meniscuses

Question 2

Which ligaments of the knee are most important for massage therapists?

Answer 2

Collateral and cruciate

Question 3

What happens to the ligaments of the knee when the knee is fully extended?

Answer 3

The cruciate ligaments twist together, causing either the femur or tibia to rotate.

Question 4

In open change knee extension, which bone twists upon full extension?

Answer 4

The tibia

Question 5

In closed chain knee extension, which bones twists upon full extenstion?

Answer 5

The femur

Question 6

The cruciate ligaments of the knee resist which movement?

Answer 6

Front to back motion

Question 7

The collateral ligaments of the knee resist which type of movement?

Answer 7

Side to side motion

Question 8

Spains

Answer 8

Injuries to ligaments

Question 9

Third degree sprain

Answer 9

The ligament is completely torn. Often makes an audible sound when it occurs. It is very painful at the moment of impact, but is then not painful.

Question 10

What types of structures can be injured in the knee?

Answer 10

Bursa, ligaments, muscles, meniscuses

Question 11

What occurs during the acute stage of an injury?

Answer 11

Inflammation

Question 12

What occurs during the sub-acute phase of an injury?

Answer 12

New fibers are created. Without application of mechanical forces, they are laid in a haphazard way.

Question 13

Function of muscle-setting exercises

Answer 13

Allows muscle-fibers to reorient themselves to resist stress.

Question 14

Function of cross-fiber friction

Answer 14

Tears fibers wheich are oriented the wrong way.

Question 15

What types on injuries need to be referred to a GP or the ER?

Answer 15

Third degree sprain and broken bones.

Question 16

Specificity of a test

Answer 16

How well the test can actually target the correct structure

Question 17

Reliability of a test

Answer 17

How well can the test actually find the injury that it is looking for

Question 18

Which structures do we test in the knee during integrity tests?

Answer 18

Ligaments, meniscuses, articular cartilage, bursa and peri-tendons.

Question 19

Peritendons

Answer 19

Outer coating of a tendon

Question 20

Bounce test application

Answer 20

Patient supine, lift the leg and allow it to bounce off of the table

Question 21

Positive indication of the bounce test

Answer 21

Lack of bouncing, apprehension or pain

Question 22

Structures tested by the bounce test

Answer 22

All in a general sense

Question 22

Appley’s compression test application

Answer 22

Patient is prone with knee bent to 90 degrees. Use one hand to feel posterior knee and other to lock ankle and compress the leg. Twist the leg using the calcaneous as a handle.

Question 23

Structure tested by Appley’s compression test

Answer 23

The meniscuses

Question 24

Appley's decompression test application

Answer 24

Same positioning as the compression test. Instead, pull the leg upward and twist while holding the femur down.

Question 25

Structures being tested in Appley's deocmpression test

Answer 25

All 4 primary ligaments of the knee.

Question 26

Positive indications in Appley's testing

Answer 26

Popping, clicking, pain or excessive ROM

Question 27

Structure being tested in McMurray's test

Answer 27

The meniscuses

Question 28

Positive indications in McMurray's test

Answer 28

Popping, clicking, pain, excessive ROM, locking of the knee.

Question 29

McMurray's test application

Answer 29

Patient supine. Perform passive knee extension while using the calcaneous to dorsiflex the ankle and twist the tibia.

Question 30

Structure being assessed in Noble's test

Answer 30

The iliotibial band

Question 31

Application of Noble's test

Answer 31

Passively flex and extend the knee with the thumb on the lateral condyle of the femur. Monitor the femoral condyle around 30 to 35 degrees of flexion because the IT band flicks across.

Question 32

Structures tested in the drawer test for the knee

Answer 32

Cruciate ligaments

Question 33

Application of the drawer test for the knee

Answer 33

Hold the knee at around 90 degrees of flexion. Brace the foot (maybe sit on it) and move the tibia back and forth on the femur.

Question 34

Which portion of the drawer test tests the anterior cruciate ligament?

Answer 34

Pulling the tibia anterior

Question 35

Which portion of the drawer test tests the posterior cruciate ligament?

Answer 35

Pushing the tibia posteriorly.

Question 36

How many primary bursa does the knee have?

Answer 36

8

Question 37

Structure assessed in Zohler's test

Answer 37

The subpatellar articulating cartilage.

Question 38

Application of Zohler's test

Answer 38

Use thumb and index finger to hold the patella distally. Have patient lightly contract quadriceps.

Question 39

Positive indication in Zohler's test

Answer 39

Gross asymmetry, excessive grinding

Question 40

Structures tested in the Figure 8 test

Answer 40

Collateral ligaments (during stretched phase) and meniscuses (during compressed phase)

Question 41

Application of figure 8 test

Answer 41

Pull the leg off of the side of the table and place patient's ankle between practitioner's knees. Stretch or compress leg while applying medial and lateral forces to knee.

Question 42

Positive indications for the figure 8 test

Answer 42

Pain, excessive ROM

Question 43

Structures tested in Ober's test

Answer 43

IT band tightness at the hip

Question 44

Ober's test application

Answer 44

Patient side-lying. The top leg is lined up with the torse and the dropped down to the table.

Question 45

Positive indications for Ober's test

Answer 45

The leg won't drop all the way to the table and/or hip moves.

Question 46

How can a massage practitioner loosen the IT band?

Answer 46

By working the muscles which attach to the IT band. These include glute max and TFL.

Question 47

Patient positioning for active and passive ROM testing for knee extension

Answer 47

Suping with hip at 90 degrees.

Question 48

Patient positioning for resisted ROM for knee extension

Answer 48

Prone with the knee at 90 degrees.

Question 49

Most knee extension restrictions are due to what?

Answer 49

Tight hamstrings. They also cause hip flexion restrictions.

Question 49

Strain

Answer 49

Muscular tissue tear

Question 49

What happens when one hamstring is torn?

Answer 49

The other two protectively tighten up

Question 50

When testing the ankle, focus should be directed where?

Answer 50

High up in the ankle. Motion of the foot and toes can be confusing.

Question 51

Ligament which is most commonly injured in the ankle

Answer 51

Anterior talofibular ligament. Caused by an inversion sprain.

Question 52

Application of drawer test for anterior talofibular ligament

Answer 52

One hand braces the shin, the other pulls the heel forward. Altervatively, brace the foot and push the shin back.

Question 53

Which muscles are of not in the posterior compartment of the calf?

Answer 53

Gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, flexor digitorum

Question 54

Which muscles are of note in the lateral compartment of the calf?

Answer 54

All 3 peroneus/fibularis muscles

Question 55

Muscles of note in the anterior compartment of the lower leg

Answer 55

Tibialis anterior, extensor digitorum longus, extensor digitorum hallucis

Question 56

Exercise to strengthen the muscles of the anterior compartment of the leg

Answer 56

Walking with the toes up

Question 57

Exercise to strengthen the lateral compartment of the leg

Answer 57

Walking with the outside of the foot lifted

Question 58

Exercise to strengthen the tibialis muscles

Answer 58

Walk with the inside of the foot lifted

Question 59

Exercise to combat fallen arches

Answer 59

Shorten the foot, then perform a single leg squat

Question 60

Valgus stress

Answer 60

Stress applied from lateral to medial

Question 61

Varus stress

Answer 61

Stress applied from medial to lateral