Lecture 10 - Knee and thigh rehab

Question 1

Commonly follows the movement of the foot and hip

Answer 1

The knee

Question 2

Common MOI for traumatic injuries (2)

Answer 2

Valgus and rotational forces

Question 3

What leads to insidious onset of injuries of the knee? (2)

Answer 3

Poor biomechanics and control of hip/pelvis

Question 4

Phase 1 of overall rehab of knee injuries

Answer 4

Focus on restoration of ROM, pain modulation, inflammatory control, modification of activities, and gait training

Question 5

Phase 2 of overall rehab of knee injuries

Answer 5

Gaining full ROM
Demonstration of normal gait pattern
Basic to advanced strengthening and flexibility
Appropriate CV conditioning
Proprioception retraining

Question 6

Phase 3 of overall rehab of knee injuries

Answer 6

Functional return to prior activity level
Sport/occupational specific progression

Question 7

Grade 1 and 2 of MCL sprain typically treated with ____

Answer 7

Conservative treatment

Question 8

Grade 1 MCL sprain time to RTP

Answer 8

avg 10.6 days

Question 9

Grade 2 MCL sprain time to RTP

Answer 9

avg 19.5 days

Question 10

Chances of re-injury with a grade 3 MCL sprain

Answer 10

78%

Question 11

Strengthen what with a MCL sprain?

Answer 11

Hamstrings and quads
CKC asap (avoiding valgus forces)

Question 12

What treatment of hip/pelvis control to avoid non-contact knee valgus?

Answer 12

Hip extension, adduction, abduction, external rotators, core strength

Question 13

Important consideration for ACL sprain rehab (conservative)

Answer 13

Full range OKC knee extension should be avoided before 6-9 months following ACL surgery

Question 14

ACL sprain - OKC extension at a low load are safe and safer to use from ___ to ___ degrees of knee flexion ROM

Answer 14

90 to 40

Question 15

ACL sprain - high loads from ___ to ___ degrees of knee flexion can be harmful (can do full ROM of KE)

Answer 15

40 to 0

Question 16

ACL sprain - from ___ knee flexion (“full KE’’) to __ knee flexion, avoid OKC with high loads

Answer 16

0 to 40

Question 17

3 important things in ACL sprain rehab (conservative)

Answer 17

1. terminal knee extension ROM (hard to get back)
2. Hamstring strengthening
3. CKC = less shear forces (more proprioceptive feedback = add to rehab program)

Question 18

T or F: surgery is absolutely required if an athlete wants to return to sports with cutting after an ACL sprain?

Answer 18

TRUE

Question 19

Does not often require surgery due to its MOI

Answer 19

PCL sprain

Question 20

For meniscus tears, what is included in the 3-6 months of conservative treatment?

Answer 20

Quad strengthening, hamstring strengthening, activity modification, unloader bracing, NSAIDs, and neuromuscular retraining

Question 21

Purpose of the unloader brace

Answer 21

Puts pressure on the outside of the knee, to open the space to decrease the irritation

Question 22

Kinematics of IT band friction syndrome

Answer 22

Greater hip adduction, greater contralateral pelvic drop

Question 23

4 things to do in IT band friction syndrome

Answer 23

• Decrease training load, running speed, hill work
• Stretch the lateral chain (3x a day)
• Strengthening of the gluteus medius
• Possible change in running shoes

Question 24

Patellar tendinopathy rehab, what to avoid in activity modification?

Answer 24

Avoid jumping and implement stretching in early part of disease

Question 25

Do we use eccentric exercises in patellar tendinopathy, why?

Answer 25

YES, load on patellar tendon can be maximized

Question 26

Type of brace for patellar tendinopathy

Answer 26

Patellar strap

Question 27

Kinematics of patellar tendinopathy

Answer 27

Peak hip adduction and ankle eversion were higher in runners and tibial IR/ER was lower with PT compared to control group

Question 28

Kinematics of PFPS

Answer 28

Excessive IR of femur increase stress on patellofemoral joint, excessive pronation

Question 29

For what injury is the balance between vastus medialis and vastus lateralis is important?

Answer 29

PFPS rehab

Question 30

PFPS - in long run, ___ exercises promoting co-contraction of HS and quads has been shown to be superior

Answer 30

OKC

Question 31

PFPS, strengthen what?

Answer 31

Isolated strengthening of quadriceps (both in OKC and CKC)

Question 32

2 predisposing factors to hamstring strain

Answer 32

Strength and control of the lumbopelvic structures + quadriceps tightness

Question 33

Type of strengthening for hamstring strain?

Answer 33

Eccentric strength

Question 34

___ and __ shown to be superior to standard stretch and strengthening in hamstring strain rehab

Answer 34

Trunk stabilization and agility

Question 35

Why is a hamstring strain rehab so long?

Answer 35

Because athlete RTP too soon (use taping, bracing, until end of season, play with pain) and because it takes time to change the postural motions that causes it (ex: anterior pelvic tilt)

Question 36

Typical muscle of quadriceps that his strained

Answer 36

Rectus femoris

Question 37

What exercises are targeted for rehab of quad strain? (4)

Answer 37

Stretching, strengthening, proprioceptive, and functional training exercises

Question 38

Complication of quad strains

Answer 38

Myositis ossificans

Question 39

What to do in the first 24-48h with a quad contusion?

Answer 39

Stretching

Question 40

Kinematics of patellar dislocation

Answer 40

Patellar/femur structure, medial and lateral retinaculum, valgus forces on knee

Question 41

Can you use taping for patellar dislocation?

Answer 41

YES

Question 42

Goal of patellar dislocation rehab (general)

Answer 42

Decrease swelling Promote VMO and gluteal activity

Question 43

What to use for ROM of the knee in early rehab of patellar dislocation?

Answer 43

Bike

Question 44

Patellar dislocation - literature is leaning towards ___ more effective than __ strengthening

Answer 44

more CKC than OKC

Question 45

Patellar dislocation - common to see knee lock/unlock at 20-30d, what to do to correct? (3)

Answer 45

Mini squats VMO and VL timing emphasis Optimal lower body alignement re-training

Question 46

Excellent exercise for gaining ROM

Answer 46

Exercise bike (pendulum = full revolutions)