Masterclass 4 Flashcards by Tom Havill

Where is the apex of the patella?

The inferior aspect

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Common cause of patella tendinopathy

Jumping, COD, running downhill

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How do weak lower body muscles contribute to patella tendinopathy

Leads to dysfunction of the lower limb and increases load on patella tendon

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What is a subjective PROM to use on patella tendinopathy pt

VISA-P

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What are the 4 things that should be done to assist in rehabilitating patella tendinopathy

Load reduction
Isometrics
Strengthening
Taping

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Should tendinopathy pt have injection therapies

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Should tendinopathy pt stretch

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What are risk factors for PFP

Female
Knee ext strength
Hip strength

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Where is pain most common in PFP pt

On and around the patella

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When is pain worse in PFP pt?

Loaded positions e.g running, squatting, jumping, sitting down

Knee flexion

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Treatment options for PFP pts

Patella taping
Patella mobilisation
Orthotics
Gait retraining

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Common impairments of PFP pt

Hip and knee strength
Flexibility (calves, quads, hammy)
Reduced DF
Foot Pronation

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Does crepitus a cause of PFP

No but it is common in those pt

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Examples of Stage 1 rehab for patella tendinopathy

Anything Isometric. Aim for 5x45sec
Don’t let the muscle start shaking.

e.g
Banded TKE
Knee ext holds

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Stage 2 rehab for patella tendinopathy

Isotonic
Start 3-4 sets 15RM, progress towards 6RM
Perform every 2nd day

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Stage 3 rehab for patella tendinopathy

Energy Storage Loading
Progress volume before intensity
Perform every 3rd day
Jumping, accel, decel, running & cutting
No more than 3 high intensity training or competition per week for the first year of return

Knee OA symptoms

Pain
Stiffness
Instability
Noises (crunching/clicking)
Reduced functioning

What is OA pathologically described to be (hint: its not bone on bone)

Inflammation of not just the knee joint, but the entire body (biopsychosocial model)

Knee OA risk factors

Age
Female
Obesity
Injury history (ACL rupture, meniscus, surgery)
Manual labourers
Physical inactivity

Diagnosis of knee OA

NICE guidelines

Knee OA treatment

EVERYONE should receive education, exercise and weight control

SOME should receive pharmalogical pain relief and manual therapy

FEW should require surgery

What is a often forgotten education point for people with knee OA

Biopsychosocial factors

beliefs, fear, self—efficacy, pain catastrophizing

What does the GLA:D physical activity guidelines for knee OA include

Warm up – static bike
Lower limb strength
Kinetic chain
Task-specific practice/difficulties
Cooldown/walking/stretching
Dose: 2-3 sets of 10-15 reps with appropriate progression guided by pain response

How does weight reduction affect pain in knee OA pt

5% reduction in weight = decreased pain intensity by 30%

10% reduction in weight = decreased pain intensity by 50%

What muscles are often under-utilised in fat pad impingement pt contributing to the injury

Hamstrings. They're not being used to pull the knee into flexion, leaving the knee in hyperextension

What movement is painful in fat pad impingement pt

Knee ext

Where is tender/painful in fat pad impingement pt

Medial and lateral of either side of the patella tendon

Ways to reduce inflammation in fat pad impingement pt

Limited active/passive knee ext Tape Heel cup insertion Ice for pain management

Does ITB syndrome pt commonly have knee vagus or varus

Valgus

ITB syndrome treatment options

Load management Strengthen hip and trunk Retrain gait

What causes ITB syndrome

Constant compression at around 20-30 deg of knee flexion

What causes fat pad syndrome

Constant overextension (e.g sitting on couch with legs on coffee table) Patellar dislocation

What can be commonly observed in fat pad injury pts (stance)

knees in hyper extension

What movement causes pain in patellar tendinopathy vs patella fat pad injuries

Tendinopathy - Squatting, jumping Fat pad - flexion and extension (painful walking up AND down stairs) + walking

Early rehab exercise for fat pad injuries

Pt stands with the asymptomatic leg closest to the wall at a distance of a fist away from the wall. The patient’s whole body is turned 45 into the wall and the weight is transferred to the outside (symptomatic) leg. The knee of the leg closest to the wall is flexed to 60 with the knee touching, not pushing the wall, for balance purposes. The foot is off the ground. The hips are kept in neutral position so the thighs are parallel. The patient’s weight is directed through the heel of the weight-bearing leg, the pelvis is slightly posteriorly tilted and the knee is just off lock (slightly flexed). The patient slightly externally rotates the standing leg without turning the foot, the pelvis, or the shoulders. The patient should sustain the contraction for 15 to 20 seconds and repeat often during the day