Knee Techniques

Question 1

Chondromalacia Patella/ Patellofemoral Stress Syndrome

Answer 1

• Deterioration/Inflammation of the articular cartilage of the patella
  ~ Causes:
  > Simple wear and tear
  > Patellar Maltracking
  • Hypomobility (quads or
  retinaculum are too tight)
  • Diminished NMC
  • Break down of patellar position
  maintenance factors
• Chondromalacia Patella
  ~ softening of the cartilage of the
  underside of patella
• Patellofemoral Stress Syndrome
  ~ bone on top of bone (patella and
  femur) due to loss of cartilage

Question 2

Chondromalacia Patella/ Patellofemoral Stress Syndrome: S&S

Answer 2

• Pain on Facets of Patella
• Pain worse with mid/full loaded knee flexion.
  ~ patella goes into femoral groove
  when loading
• Swelling around patella.

Question 3

Chondromalacia Patella/ Patellofemoral Stress Syndrome: Common Problems/Limitations

Answer 3

• Antalgic Gait
• Structural Foot Deformities
• Leg Length Discrepancy
• Limited Hip ROM
• Muscle Weakness at knee and/or Hip.

Question 4

Chondromalacia Patella/ Patellofemoral Stress Syndrome: Common Treatment Approaches

Answer 4

• Stretching
• Selective Strengthening
• Bracing
• Taping
• Surgery
  ~ Causes scar tissue, making ROM
  worse

Question 5

Chondromalacia Patella/ Patellofemoral Stress Syndrome: Alternative Treatment Approach

Answer 5

• Stop blaming/treating the “train”(patella) and focus more on the “track” (femur)
• What influences movement of the track?
  ~ Hip Motion
  ~ Foot Motion
• Femur and tibia must be in sync.

Question 6

ACL Injuries/Reconstruction: Common Problems/Limitations

Answer 6

• Antalgic Gait
• NWB/PWB: dependent on if other structures are involved
• Diminished Knee Flexion/Extension ROM
• Quad Atrophy
• Weakness Especially with Knee Extension
• Hip ROM Limitations Especially Extension and IR: Apprehension
• Instability: NMC isn’t present

Question 7

ACL Injuries/Reconstruction: Integrated Isolation

Answer 7

• What tissues are involved?
  ~ ACL
• What joints does the tissue control/stabilize?
  ~ Tibiofemoral
• What other tissues does the involved tissue work with?
  ~ Quads
  ~ Posterior Lower Leg
  > controls Tibiofemoral joint
  > controls Femur IR (gastroc)
  ~ Muscles controlling the hip and foot

Question 8

MCL/LCL Injuries: Common Problems/Limitations

Answer 8

• Antalgic Gait
• NWB/PWB
• Diminished Knee Flexion/Extension ROM
• Weakness
• Instability Especially with MCL
  ~ during normal function the MCL is
  stressed more than LCL

Question 9

MCL/LCL Injuries: Integrated Isolation

Answer 9

• LCL
  ~ Difficult to apply concepts of
  “integrated isolation” and “causative
  cure” since the mechanism of injury is
  often a highly abnormal movement.
  ~ This fact is reinforced when
  considering the size of the medial
  structures vs. the lateral structure.
  > Much larger medially.
• MCL
  ~ What tissue is Involved?
  > MCL
  ~ What joints does the tissue control/
  stabilize?
  > Tibiofemoral
  ~ What other tissues does the tissue
  work with?
  > ACL
  > Quads
  > Posterior Lower Leg
  • Controls Tibiofemoral
  > Muscles controlling hip and foot