Unit 4: Knee

Anatomy Bones: Femur Tibia Fibula Patella- “knee cap”

Anatomy Meniscus 2 fibrocartilages: Functions: Medial (C shaped) Lateral (O shaped) Functions: Deepen articular facets of tibia Cushion any stresses Maintain space between femoral condyles and tibial plateaus

Anatomy Ligaments Anterior Cruciate Ligament (ACL) Prevents the femur from moving posteriorly during WB Limits anterior translation of tibia in non-WB Posterior Cruciate Ligament (PCL) Resists internal rotation of the tibia Prevents hyperextension of knee Limits posterior translation of tibia in non-WB

Anatomy Ligaments cont’d Medial collateral ligament (MCL) Prevents valgus force Lateral collateral ligament (LCL) Prevents varus force

Muscles Knee flexion Knee extension External Rotation Internal Rotation Hamstrings Gracilis Sartorius Gastrocnemius Popliteus Soleus Quadriceps Biceps femoris Semitendinosus Semimembranosus

posterior

anterior

Evaluation- History Mechanism of injury is really important Mechanics How did it happen? Overuse vs acute How long has it been happening Mechanics Distinguishing between muscular, bony, or ligamentous injury Type of pain Did they hear or feel a pop? Clicking? Grinding?

Evaluation- Observation Position of the patella Baja, alta, squinting, frog-eyed Knee position Genu valgum, genu varum, genu recurvatum Q-angle Swelling

Evaluation- Palpation Bones Joint line – medial and lateral Femoral condyles – medial and lateral Tibial plateau Head of fibula Patella Tibial tuberosity Ligaments – MCL and LCL Muscles – quadriceps, hamstrings, adductors, IT band

ROM Motion/movement Normal ROM Knee flexion 135-145 degs Knee extension 0-2 degs

Evaluation- Special Tests Muscle testing Quadriceps Hamstrings Adductors Abductors

Evaluation- Special tests What it tests for… Video Varus stress test LCL https://www.youtube.com/watch?v=sg1gk6QKARw&spfreload=10 Valgus stress test MCL https://www.youtube.com/watch?v=GSFbttpxCuQ Anterior Drawer ACL https://www.youtube.com/watch?v=IdnBKv38EEQ Lachman https://www.youtube.com/watch?v=gfN-p-xZx24 Posterior drawer PCL https://www.youtube.com/watch?v=KAUDTMu8fS0 McMurray’s test meniscus https://www.youtube.com/watch?v=lwDFPAyGGgI Obers test IT band/TFL https://www.youtube.com/watch?v=bDAHkXO1YWk

Positive tests Lachman Valgus https://www.youtube.com/watch?v=8maLLODKJwk Valgus https://www.youtube.com/watch?v=etjao_65Kp0

Knee injuries MCL sprain ACL sprain Meniscal injuries Patellofemoral pain syndrome Patellar tendinitis IT band syndrome

Knee Injuries MCL Sprain MOI: direct blow from the lateral side in a medial direction (valgus force) or from lateral tibial rotation Signs and symptoms: Instability of the knee joint Pain in medial aspect Swelling (depending on severity) ROM changes Treatment: RICE Crutches or splint Gradual rehab Refer to doctor depending on severity

Knee injuries ACL sprain

Knee injuries Menisical injuries MOI: weight bearing combined with a rotary force while the knee is extended or flexed Signs and symptoms: Swelling Joint line pain Loss of motion Locking, catching, or giving away of joint Treatment: Conservative rehab Refer to doctor  may need surgical intervention

Knee injuries Patellofemoral pain syndrome lateral deviation of the patella as it tracks in the femoral groove Tight hamstrings or gastroc Tight lateral retinaculum Tight IT band Patella alta Vastus medialis weakness Signs and symptoms: dull ache in center of knee, patellar pain and crepitus, swelling Treatment: stretching and strengthening program

Knee injuries Patellar tendinitis AKA jumpers knee MOI: jumping, kicking, running (repetitively) Signs and symptoms: Pain and tenderness at the inferior angle of patella Pain may progress depending on severity (after activity, during activity) Treatment: ice, modalities, ice, rehab

Knee injuries IT band syndrome AKA runner’s or cyclist’s knee MOI: length leg discrepancy, genu varum, pronated feet, muscular tightness Signs and symptoms: pain along the lateral leg and knee Treatment: Correction foot alignments Ice massage Proper warm up and stretching

Rehab In small groups come up with a 3 day ankle/lower leg rehab program Show progression through the program Pick one of these injuries: ACL injuries MCL injuries Meniscus injuries Quad strain Hamstring strain

Rehab Exercises for knee rehab… Lunges Squats (DL and SL) Bulgarian squats Side shuffles with band SL hopping